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© 



400 Seventh Street, S.W. 
Washington, D.C. 20590 

U.S. Department 
of Transportation 

National Highway 
Traffic Safety 
Administration 



Dear Crash Data Researchers /Users: 

Thank you for choosing crash data from the National Highway Traffic Safety 
Administration (NHTSA) for your research or other use. The information contained in 
this motor vehicle crash report is collected, maintained and distributed in accordance with 
Public Law 89-564. In accordance with this Public Law, NHTSA is required not to 
release any case information until completion of quality control procedures. These 
procedures include a review of the case material to extract all names, licenses and 
registration numbers, non-coded interview material, non-research related researcher 
comments in the margins, non- factual data, and the production number portion of the 
vehicle identification number (VIN). 

If you requested NHTSA to query its database files in order to identify a specific crash, 
then that query was made using non-personal descriptors you provided for use in our 
search. This motor vehicle crash may have been identified from a data search and 
matches the general, non-personal descriptors you provided, but we cannot confirm that 
this is the specific crash report you requested. 

If you have any questions with regard to the above procedures, please contact the Field 
Operations Branch, Crash Investigation Division, National Center for Statistics and 
Analysis at 202-366-4820. Again, please be advised that we cannot confirm that this is 
the case that you have specifically requested nor can we certify the information to be 
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£$$ *** *** 




^V^^^^~~ AUTO SAFETY HOTLINE 

Q*t « tOW**** (800) 424-9393 

SAFETY BELTS SAVE LIVES Wash D C *~ 3BM,B 



UMTRI - 96 - 8 
VERSION 05 



UM-3741-98 

1998 FORD ESCORT 

n-depth 



Vehicle 
Occupant 
Report 



The University 

of Michigan 

Transportation 

Research Institute 







DISCLAIMERS 



This document is disseminated under the sponsorship of the Department of Transportation in the 
interest of information exchange. The United States Government assumes no responsibility for 
the contents or use thereof. 

The opinions, findings, and conclusions expressed in this publication are those of the authors and 
not necessarily those of the National Highway Traffic Safety Administration. 

The crash investigation process is an inexact science which requires that physical evidence such 
as skid marks, vehicular damage measurements, and occupant contact points are coupled with 
the investigator's expert knowledge and experience of vehicle dynamics and occupant kinematics 
in order to determine the pre-crash, crash, and post-crash movements of involved vehicles and 
occupants. 

Because each crash is a unique sequence of events, generalized conclusions cannot be made 
concerning the crashworthiness performance of the involved vehicle(s) or their safety systems. 



UM-3741-98 



CaseVeh. (A): 1998 Ford 
Type: Escort SE, 4-door sedan 
Driver: 35-year-old female 
CDC: 12-FZEW-2 



Vehicle (B): 1998 Ford 

Type: F150, 4x2 supercab styleside pickup 

Driver: 28-year-old male 

CDC: 99-0000-0 



Situation 

(Slide 1, 2) At the time, the weather was clear, the roads were dry, and it was 
daylight. Case vehicle (A) was traveling east at a driver-estimated speed of 89 kph (55 
mph) in the eastbound lane of a 2-lane asphalt road in a rural area. Vehicle (B) was 
traveling west at an unknown speed in the westbound lane of the 2-lane roadway, and the 
sun reportedly was very bright, limiting visibility. As case vehicle (A) approached a 3-leg 
intersection, the driver of vehicle (B) began making a left turn across the eastbound lane, so 
as to travel south. The driver of case vehicle (A) reportedly applied the brakes, but was 
unable to avoid striking the right rear of vehicle (B) with its front. 

(Slide 3, 4, 5, 6, 7) Using the WinSMASH accident-reconstruction program and c- 
values measured for case vehicle (A), the following equivalent barrier speeds were 
calculated: 



Vehicle 


Variable 


Calculated Velocity Change - kph (mph) 


Total Longitudinal Latitudinal 


Case Vehicle (A) 


EBS 


20(13) -20 (-12) 4(2) 



Exterior Damage 

(Slide 8) Damage to the front of case vehicle (A) was minor with a maximum crush 
of 28 cm to the center-front bumper. (Slide 9) The direct damage began at the right-front 
bumper corner and extended 76 cm across the front, resulting in 51 percent front-end 
overlap and 51 percent vehicle overlap. (Slide 10) The front bumper was crushed, the 



grille was damaged, and the right headlight assembly was broken. (Slide 11) The hood 
was crushed, and the rear edge of the hood was elevated, but it did not contact the 
undamaged windshield. There was no damage to the hood latch or hood hinges. (Slide 
12) On the right side, the front fender was deformed. There was no other damage to the 
right side and no change in the right wheelbase. (Slide 13) There was no damage to the left 
side and no change in the left wheelbase. 

Interior Damage 

This vehicle is equipped with steering-wheel and passenger frontal- impact airbags. 
(Slide 14, 15) The steering-wheel airbag deployed, but for an unknown reason, the 
passenger airbag did not deploy in this frontal crash. (Slide 16) There were no visible 
contact marks to the steering-wheel airbag skin. (Slide 17, 18) There was no damage to the 
steering wheel and no rotation of the steering column. (Slide 19, 20) There was no damage 
to the upper, mid, or lower portions of the instrument panel, although there was a scuff 
mark left of the steering column on the lower portion of the instrument panel. (Slide 21) 
There was no damage to the vertical console area, but there was a scuff mark on the center 
console just to the left of the radio controls. (Slide 22) Also, there was a light scuff mark 
on the glove compartment area. There was no other interior damage and no intrusions were 
noted. 

Occupant Kinematics and Injuries 

(Slide 23, 24) The 35-year-old female driver was wearing the available 3-point 
belt, and the steering-wheel airbag deployed during this frontal impact. She reportedly had 
the seat in the forward-most seat-track position, and the tilt steering wheel in the up 
position. The shoulder-belt anchor adjuster was set to the up position on the B-pillar. 
During the frontal impact, she moved forward into the belt and deploying airbag. She 
sustained a contusion to her left shoulder from loading by the shoulder portion of the 3- 



point belt. She sustained a cervical strain, probably from impact forces or airbag 
deployment. She sustained abrasions to her right anterior upper arm, right anterior elbow, 
right anterior forearm, right anterior wrist, and to the top of her right and left thumbs, from 
the deploying airbag. (Slide 25, 26) Scuff marks were located on the lower portion of the 
instrument panel and vertical console, but no injuries were noted from this contact. 

(Slide 27) The 38-year-old male, right-front passenger was wearing the 3-point 
belt. His seat was reportedly in the rear-most seat-track position and the shoulder-belt 
adjuster was set to the low position on the B-pillar. (Slide 28) A passenger frontal-impact 
airbag was supplied in this occupant area, but it did not deploy. (Slide 29) Although there 
was a scuff mark on the glove compartment area, no injury was noted. The passenger did 
not sustain any injuries. 

(Slide 30) The 3-year-old female, left-rear passenger was wearing the available 3- 
point belt, and was seated in a4i KP booster seat. The booster seat was equipped 
with a shield, but the shield was not being used. She did not sustain any injuries. 

(Slide 31, 32) The 6-year-old male, right-rear passenger was wearing the available 
3-point belt, that was equipped with a^JHfcAdjust-A-Belt (shoulder belt positioner). 
After the crash, he complained of chest and head pain, but did not sustain any notable 
injuries. 

(Slide 33, 34, 35, 36) The attached tables summarize the injury information for the 
four occupants. 



Occupant: Driver 

Restraints: 3-point belt worn; airbag deployed 



Age: 35 years 

Stature: 160 cm (5 ft 3 in) 



Sex: Female 

Mass: 52 kg (115 lb) 



Injury Description 


A.I.S. 


Injury Source 


Definite 


Probable 


Possible 


Cervical strain 


1 




Impact forces, airbag 




Contusion, left shoulder 


1 


3-point belt (shoulder 
portion) 






Abrasion, right anterior upper arm 


1 


Airbag 






Abrasion, right anterior elbow 


1 


Airbag 






Abrasion, right anterior forearm 


1 


Airbag 






Abrasion, right anterior wrist 


1 


Airbag 






Abrasion, top of right thumb 


1 


Airbag 






Abrasion, top of left thumb 


1 


Airbag 






Maximum A.I.S. Level 


I 








Injurv Severitv Score 


2 









Occupant: Right front 

Restraints: 3-point belt worn; airbag did not deploy 



Age: 38 years 

Stature: 185 cm (6 ft 1 in) 



Sex: Male 

Mass: 86 kg (190 lb) 



Injury Description 



A.LS. 



Definite 



Injury Source 



Probable 



Possible 



No injury 



Maximum A.LS. Level 



Injury Severity Score 








Occupant: Left rear 

Restraints: 3-point belt worn with a Fisher-Price 
booster seat (shield was not being used) 



Age: 3 years 

Stature: 76 cm (2 ft 6 in) 



Sex: Female 
Mass: 15 kg (32 lb) 



Injury Description 



A.LS. 



Definite 



Injury Source 



Probable 



Possible 



No injury 



Maximum A.LS. Level 



Injury Severity Score 








Occupant: Right rear 
Restraints: 3-point belt worn with Gerry 
Adjust- A-Belt (shoulder belt positioner) 



Age: 6 years 

Stature: 135 cm (4 ft 5 in) 



Sex: Male 

Mass: 23 kg (50 lb) 



Injury Description 



A.I.S. 



Definite 



Injury Source 



Probable 



Possible 



No injury 



Maximum A.I.S. Level 



Injury Severity Score 








VERSION 05 



996 



Administrative AD-1 



TEAM CODE 
ACCIDENT ID 
VEHICLE NUMBER 
MODULE 
FORMAT 
FORM VERSION 



2.9- 

3 7 



A .B 



JL J. 

11 
13 



NO. OF CASE VEHICLES IN ACCIDENT jL 

15 

2i. 



NUMBER OF SLIDES 
TEAM REPORT NUMBER 



16 



ujy>— 3_ 7 J/J. JZJJL 



16 



27 



26 



37 



SPECIAL STUDY 

(00) None 

(01) Offset Frontal 
(98) Not Applicable 



ji 



DATE OF FIELD INVESTIGATION: 

INVESTIGATOR: 

LOCATION WHERE VEHU 





CIRCLE PHOTO RECORDS MADE: 
SLIDES 
NEGATIVES 
POLAROIDS 




REPORT PREPARED BY: 




BEST AVAILABLE COPY 



Duplicate columns 1-8 Module J3 L Format J2 L. 


General Information i 


Gl-1 


from the previous card. 9 10 1 


1 12 






Time 




Environmental Conditions 
construction zone 




DATE OF COLLISION / / 

mm d d 




(0) NO 





y y 






(1) YES 








(9) UNKNOWN 


31 


HOUR OF COLLISION 








(24 HOUR CLOCK) » » 




ROAD ALIGNMENT 
VERTICAL PLANE 

(1) LEVEL 

(2) CREST OF HILL 


_/_ 


Location 




STATE! AAICHIL*^ 




(3) SLOPE (2%) 

(4) BOTTOM OF HIU 
(9) UNKNOWN 


32 


STATE FIPS CODE 


Q-6 


ROAD ALIGNMENT 






T5 57" 


HORIZONTAL PLANE 




AREA 




(1) STRAIGHT 


_/ 




P- 


(2) CURVE 


(1) URBAN 


(3) T • SHAPED 


33 


(2) RURAL 




(4) Y - SHAPED 




(9) UNKNOWN 


~"sr 


<J\ OTHER: 








(9) UNKNOWN 
SURFACE COVERING 


J.9. 


Environmental Conditions 




LIMITED-ACCESS HIGHWAY 




(10) DRY 


(0) NO 







34 3ft 


(1) YES 


(21) WATER -DAMP 




(9) UNKNOWN 


*T8T 


(22) WATER -WET 








(23) WATER • PUDDLED 

(29) WATER - AMOUNT UNKNOWN 




ROAD, TOTAL TRAFFIC LANES 








(FOR CASE VEHICLE) 




(31) SNOW -LOOSE 

(32) SNOW -PACKED 




(1) 1-LANE 




(39) SNOW -CONDITION UNKNOWN 




(2) 2-LANES 


3 






(3) 3-LANES 


(41) ICE 




(4) 4 OR MORE LANES 


27 


(51) SLUSH 




(5) DIVIDED. 4 OR MORE LANES 




(61) SPILLED GRAVEL 




(6) PARKING LOT/DRIVEWAY 
(71 OTHER: 




(71) OTHER! 




(99) UNKNOWN 


(9) UNKNOWN 






VISIBILITY LIMITATION 








(FOR CASE VEHICLE) 




INTERSECTING RD. TOTAL LANES 









CHOOSE FROM ABOVE UST, OR 




(0) NONE 




a 


(1) CLOUDY/DARK 




(8) NOT APPLICABLE 


(2) FOG 


36 




"T5" 


(3) SMOKE 

(4) WINDSHIELD CONDITION 

(5) GLARE 




TYPE OF ROAD SURFACE 




(6) RAIN 






/ 


m OTHER- 




(1) ASPHALT 


(8) ICE/SNOW 




(2) CONCRETE 




(9) UNKNOWN 




(3) GRAVEL 

(4) MORE THAN ONE (CIRCLE EACH) 


20 


VISIBILITY OBSTRUCTION 




(7\ OTHER: 




(FOR CASE VEHICLE) 


^B 


(9) UNKNOWN 






(0) NONE 









(1) BUILDING 




ROAD DEFECTS 




(2) SIGN 

(3) VEGETATION (E.g. bushes, shrubs) 


37 


(0) NO 





(4) TREE 




(1) YES 


(5) HILL OR CURVE IN ROAD 




(9) UNKNOWN 


"35" 


(6) VEHICLE IN TRANSPORT 

(7) OTHER: 








(6) PARKED VEHICLE 








(9) UNKNOWN 





BEST AVAILABLE COPY 



General Information G 1-2 


Environmental Conditions 




Mechanical Malfunction 


SPEED LIMIT 




. 




4 


WAS THERE MENTION 


(O) 5-45 km/h 5-25 mph 


OF A MECHANICAL MALFUNCTION 


(1) 46-55 30 


36 


IN CASE VEHICLE 


(2) 56-60 35 




(0) no i _ri 


(3) 61-70 40 




(4) 71-79 45 




(1) YES 44 


(5) 80-85 50 




(2) YES. DID NOT CONTRIBUTE ; 


(6) 86-90 55 " 




TO ACCIDENT | 


(7) 91-105 60 




(9) UNKNOWN 


(8) OVER 105 65 






(9) UNKNOWN 

PRECIPITATION 




! 








THE FOLLOWING SECTION SHOULD BE FILLED 


. (0) NONE 





OUT IF A MECHANICAL MALFUNCTION IS 


(1) RAIN 


RECOGNIZED OR SUSPECTED 


(2) SNOW 


39 




(3) HAIL 




QBSLE ITEMS INVOLVED. SUPPORT ANY 


(4) FREEZING RAIN/SLEET 




ITEMS CIRCLED WITH COMMENTS. 


(7) OTHER: 






(9) UNKNOWN 




BRAKE SYSTEM DRIVER CONTROLS 


RATE OF PRECIPITATION 




EXHAUST SYSTEM POWER TRAIN 


(1) LIGHT/MIST 


? 




(2) MODERATE 


STEERING SYSTEM FUEL SYSTEM 


(3) HEAVY 


40 




(8) NOT APPLICABLE 




SUSPENSION SYSTEM VISIBILITY ITEMS 


(9) UNKNOWN 




ELECTRICAL SYSTEM TIRES 


TEMPERATURE 




THROTTLE CONTROLS UNKNOWN 


(0) BELOW -15° C BELOW 5° F 


9 




(1) -15 TO -6 5 TO 22 


_Z 


OTHER: 


(2) -5 TO -1 23 TO 31 


I 




(3) TO 2 32 TO 36 






(4) 3 TO 5 37 TO 41 




COMMENTS: 


(5) 6 TO 15 42 TO 59 






(6) 1 6 TO 25 60 TO 77 


1 




(7) 26 TO 35 78 TO 95 




(8) OVER 35 OVER 96 

(9) UNKNOWN 

CROSSWIND 
(0) NONE 








(1) LIGHT 




(2) STRONG 


42 




(3) GUSTY & STRONG 
(9) UNKNOWN 

LIGHT CONDITIONS 
(1) DAYLIGHT 


/ 










(2) DAWN 

(3) DUSK 


43 






(4) DARK, LIGHTED 

(5) DARK, UNLIGHTED 








(6) DARK. UNKNOWN FLIGHTED 
(9) UNKNOWN 



















BEST AVAILABLE COPY 







General Information 


GI-3 


Crash Details 




HIGHEST POLICE INJURY 
SEVERITY CODE IN CRASH 


j 


CASE VEHICLE AND OBJECT 


_0 


(NOT JUST CASE VEHICLE) 


i 
i 


(0) NO 


(0) O- NO INJURY 




(1) YES 


45 


(1) C - POSSIBLE INJURY 




(9) UNKNOWN 




(2) B- NON-INCAPACITATING INJURY 

(3) A - INCAPACITATING INJURY 

(4) K- FATAL 

(5) INJURED, SEVERITY UNKNOWN 


i 


CASE VEHICLE ROLLOVER 




(6) DIED PRIOR TO ACCIDENT 


i 
t 


' 


n 


(7) NON-FATAL INJURY 


i o 


(0) NO ROLLOVER 


SEVERITY UNKNOWN 


(1) YES, FIRST EVENT 


46 


(9) UNKNOWN 


! 53 


(2) YES. SUBSEQUENT EVENT 






i 
i 


(3) YES, SEQUENCE UNKNOWN 
(9) UNKNOWN 






i 


Driver Impairment 




CASE VEHICLE RAN OFF ROADWAY 




DRIVER ALCOHOL INVOLVEMENT 




(BEFORE FIRST IMPACT) 




(CASE VEHICLE) 




(0) NO 


_0 


(0) NONE 


_0 


(1) YES 


47 


(1) YES 


54 


(9) UNKNOWN 




(9) UNKNOWN/NOT REPORTED/ 
NO DRIVER 




MOVING CASE VEHICLE AND 




DRIVER ALCOHOL BAC 




CONTACTED MOVING VEHICLE 


_/ 


(CASE VEHICLE) 


_££ 


(0) NO 


(80) NO TEST 


(1) YES 


48 


(90) CHEMICAL TESTS, NO RESULTS 


55 56 


(9) UNKNOWN 




(95) AUTOPSY, NO RESULTS 
(99) UNKNOWN 




CASE VEHICLE AND 




WAS THERE MENTION OF DRIVER 




CONTACTED STOPPED VEHICLE 




IMPAIRMENT FOR CASE VEHICLE? 




(0) NO 


_0 


(0) NO 


_0 


(1) YES 


49 


(1) YES 


57 


(9) UNKNOWN 

STOPPED CASE VEHICLE AND 




(9) UNKNOWN 




LIST IMPAIRMENTS MENTIONED: 


CONTACTED VEHICLE 








(0) NO 


Jl 










(1) YES 


50 






(9) UNKNOWN 
TOTAL NUMBER 














OF VEHICLES CONTACTED 
BY CASE VEHICLE IN CRASH 
















± 


Post -Crash Detail 




(8) 8 OR MORE 






(9) UNKNOWISI 


51 


MANNER CASE VEHICLE 
LEFT SCENE 




ANY FIRE IN THIS CRASH 




(1) DRIVEN 

(2) TOWED DUE TO DAMAGE 


_a 


(NOT JUST CASE VEHICLE) 




(3) TOWED, NOT DUE TO DAMAGE 


(0) NO 


_o 


(4) TOWED, REASON UNKNOWN 
(9) UNKNOWN 


sa 


(1) YES 


52 






(9) UNKNOWN 

i 









BEST AVAILABLE COPY 



Accident Schematic 



ACCIDENT DESCRIPTION: fjlse S/e^tClC Ca) b/AS TeAlfC t/Aj£ CASE VEHICLE (A) 

G AST AT A ~b&tU£0'fST*/UATeb rP£€d CF ffftCAHfeSniP OTHER VEHICLE (B) 
in TH? €AsT7)OQA)b lA**(s Of= A £-LA*<? gu&At Q&A& THIRD VEHICLE (C) 

v€Hicte (&)\*j*s -rnAveu^C uvesr at a* p/vica/oh/P speet> 



/in fb*> f/rd 



/?/vQ Qer.fiAi /r\/ik?}*tc 






f\ lift -rua/J /*) faoAJTor case (st^/ccer c^.th? 7ipn/tr<i af r.AJe i/€hi(llc 

Ca) HZf>ofiTe?>iy AP?l/e * TH E 7ZfiAK& .par WAi ppMLG 7Z> AlTO'Q S7/2/rt*Xj 

THE PtCrtT Si2>£ ar \/£HlCt<S fa). 



© 



NORTH 



speed limit 55 mph 



NORTH 




speed limit 55 mph 



« 



BEST AVAILABLE COPY 



Duplicate columns 1-8 
from the previous card. 



JQ_ JL. Format JL -J_ 



10 



11 12 



Other Vehicle OV-1 



make. 



fCfitt 



MODEL ?~IS& Yy2 SLfe/lc+tj ?r*£ r,»e 



CARGO: L>A/<f^<t^ 




VIN 



MANUFAC/BODY CODE 



MAKE/MODEL CODE 



MODEL YEAR 



/_5_L_ J. 2? 

34 

36 



VEHICLE MASS <*# 



Q_o__L2.t-9- 



46 



IF SEPARATE REPORT WAS MADE, O 

GIVE VEHICLE NUMBER — 



NUMBER OF OCCUPANTS 
(ENTER 9S IF UNKNOWN) 



TRAVELING SPEED (km*) 



o I 



49 



52 



(000) PARKED OR STOPPED 

(995) JUST STARTING UP 

(996) BACKING UP 

(997) SPEED NOT EXCESSIVE (BUT UNKNOWN) 

(998) SPEED EXCESSIVE (BUT UNKNOWN) 

(999) UNKNOWN 



HIGHEST POLICE INJURY SEVERITY 
CODE FOR THIS VEHICLE 

(0) O - NO INJURY 

(1) C- POSSIBLE INJURY 

(2) B - NON-INCAPACITATING INJURY 

(3) A - INCAPACITATING INJURY 

(4) K- FATAL 

(5) INJURED. SEVERITY UNKNOWN 

(6) DIED PRIOR TO ACCIDENT 

(7) NON-FATAL INJURY 

SEVERITY UNKNOWN 

(8) UNOCCUPIED VEHICLE 

(NOT APPLICABLE) 

(9) UNKNOWN 



O 



53 



VEHICLE TYPE 

PASSENGER VEHICLE 

(02) LARGE 

(03) LIMOUSINE 
(17) PICKUP CAR 

(20) UNKNOWN PASSENGER VEHICLE BODY 

(24) SUB-MINI 

(25) MINI 

(26) SUB-COMPACT 

(27) COMPACT 

(28) INTERMEDIATE 

(29) FULL 



MULTIPURPOSE PASSENGER VEHICLE 

(14) SMALL UTILITY (WHEELBASE LESS than tor, 
EG. JEEP. BRONCO) 

(15) LARGE UTILITY (wheelbase more than ior. 

EG. PANEL TRUCK SUBURBAN) 

(16) PICKUP TRUCK with canopy/shell cover 

(17) PICKUP CAR WITH CANOPY/SHELL COVER 

(21) MOTOR HOME 

(22) PICKUP TRUCK WITH SUDE4N CAMPER 

(23) PICKUP GAR WITH SLIDE-IN CAMPER 

(31) CHASSIS-MOUNTED CAMPER 



TRUCK 

(11) VAN 

(12) PICKUP TRUCK 

(13) UNKNOWN LIGHT TRUCK 

(15) LARGE UTILITY <EX3. panel truck, suburban) 

(16) PICKUP TRUCK with canopy/shell cover 

(22) PICKUP TRUCK WITH SUDE4N CAMPER 

(30) UNKNOWN TRUCK TYPE 

(31) CHASSIS-MOUNTED CAMPER 

(33) DELIVERY VAN (halkan) 

(34) STRAIGHT TRUCK 

(35) TRUCK-TRACTOR (bobtail) 

(36) CHASSIS-CAB 

(37) UNKNOWN HEAVY TRUCK 

(38) TRACTOR & SEMI-TRAILER (SEMI) 

(39) TRUCK (OR SEMI) & FULL TRAILER(S) 



BUS 

(40) UNKNOWN BUS TYPE 

(41) SCHOOL BUS 

(42) INTERCITY BUS (BETWEEN CITIES) 

(43) TRANSIT BUS (intractty) 

(44) STREETCAR (ON tracks) 

(68) TRAIN (CARS) 

(69) LOCOMOTIVE (ENGINE, SWITCHER) 



/^. 



(99) UNKNOWN 

WHEELBASE (cm) 

(999) UNKNOWN 



56 57 58 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module _Q J£_ Format.fi JL 

from the previous card. e 10 11 12 



Other Vehicle OV-2 



ORIGINAL SPECIFICATIONS 



Wheelbase 



Curb Weight 



3S3 



n<o 



cm 



kg 



Average Track Width j _T J— cm 

13 15 



Overall Length 



cm 



16 18 

/ 9 * 



Overall Width (OAW) * ? ~ cm 

19 21 



Front Overhang 

Rear Overhang 

Undeformed End Width (UEW) 

Engine Displacement _2l ■ ^ 

31 32 

Engine: # of Cylinders _^_& 

33 34 



22 24 

25 27 



cm 



28 



30 



VEHICLE DAMAGE 



£*• 



*^ t 








Round up for .5. 98 = 98% or more 
Enter % overlap or "99* for missing or N/A. 

Front-End Overlap (Percent) = DDL 

UEW 



Vehicle Overlap (Percent) = DDL + 1/2 (OAW - UEW1 

OAW 



FRONTAL CRASH OVERLAP 

Direct Damage Length (DDL) 



35 37 

38 39 



11- 



40 41 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module _¥ D_ Format JJ ]_ 

from the previous card. 9 10 11 12 



Vehicle Description VD-1 



MAKE: 
MODEL: 






CARGO: 



m#€ 




MANUFAC/BODY CODE 
MAKE/MODEL CODE 



30 34 



MODEL YEAR 1 9 _2 S_ 

VEHICLE MASS (kg) _¥ -P—l ( ? 2 



47 52 

TRAVELING SPEED (kmto) 5^ C> fs ^ 



ODOMETER (km) 

(ENTER S5 IF UNKNOWN) 
(ENTER 5'S IF ELECTRONIC) 

NUMBER OF OCCUPANTS 

(ENTER 9'S IF UNKNOWN) 



(000) PARKED OR STOPPED 

(995) JUST STARTING UP 

(996) BACKING UP 

(997) SPEED NOT EXCESSIVE (BUT UNKNOWN) 

(998) SPEED EXCESSIVE (BUT UNKNOWN) 

(999) UNKNOWN 



VEHICLE TYPE 

PASSENGER VEHICLE 

(11) 2-DOOR HARDTOP (NO UPPER B-PILLAR) 

(12) 2-DOOR SEDAN OR COUPE 

(ANY UPPER B-PILLAR) 

(13) 4-DOOR HARDTOP 

(14) 4-DOOR SEDAN 

(15) STATION WAGON 

(16) CONVERTIBLE 

(18) OTHER PASS. VEH. : 

(19) PASSENGER VEHICLE, TYPE UNKNOWN 

MULTIPURPOSE PASSENGER VEHICLE 

(21) SMALL UTILITY <EGL JEEP. SCOUT. BRONCO) 

(22) LARGE UTILITY (EG. panel truck, suburban) 

(23) VAN. SIZE UNKNOWN 

(24) VAN, SMALL WNt) 

(25) van, large 

(29) mpv, type unknown 

(30) motor home 

Truck 

(31) pickup truck, unknown 

(32) PICKUP TRUCK, SMALL (downsized) 

(33) PICKUP TRUCK. LARGE 

(99) UNKNOWN 



58 59 



STOLEN VEHICLE 

(0) NO 

(1) YES 

(8) NOT COLLECTED 

(9) UNKNOWN 



BODY STRUCTURE 

(1) BODY & FRAME 

(2) UNITIZED 

(3) INTEGRAL-STUB FRAME 

(4) BODY & PLATFORM FRAME 
(E.G. VWBUG) 

(5) PARTIALLY UNITIZED 
(7) OTHER:. 



60 



(9) UNKNOWN 



TRANSMISSION 

(0) NONE 

(1) AUTOMATIC 

(2) MANUAL 
(9) UNKNOWN 



LOCATION OF TRANSMISSION 
SELECTOR LEVER 



61 



(D 
(2) 
(3) 
(7) 
(9) 



FLOOR 

CONSOLE 

COLUMN 

OTHER: 

UNKNOWN 



STEERING 

(1) POWER 

(2) MANUAL 
(9) UNKNOWN 



BRAKES 

(1) POWER 

(2) MANUAL 
(9) UNKNOWN 



63 



J 



J 



65 



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Vehicle Description VD-2 



TYPE OF BRAKES 

(1) DRUM, ALL WHEELS 

(2) DlSC t FRONT WHEELS 

(3) DISC, ALL WHEELS 
(9) UNKNOWN 



BRAKE ANTI-LOCK DEVICE 

(0) NONE INSTALLED 

(1) TWO-WHEEL 

(2) FOUR-WHEEL 

(7) EQUIPPED, UNKNOWN WHEELS 
(9) UNKNOWN 



AIR CONDITIONING IN VEHICLE 

(0) NO 

(1) YES 

(8) NOT COLLECTED 

(9) UNKNOWN 



TYPE OF DRIVE 

(1) REAR WHEEL 

(2) FRONT WHEEL 

(3) FOUR WHEEL 

(4) ALL WHEEL DRIVE 
(9) UNKNOWN 



DUAL REAR WHEELS 

(0) NO 

(1) YES 

(9) UNKNOWN 



ORIGINAL TYPE 

OF RESTRAINT SYSTEM 

(1) ACTIVE BELT 

(2) PASSIVE BELT 

(3) AIRBAG 

(4) KNEE BOLSTERS 






(7) OTHER: 

(8) NOT APPLICABLE (NOT EQUIPPED) 

(9) UNKNOWN 



EQUIPPED WITH ROLL BAR 

(0) NO 

(1) YES 

(9) UNKNOWN 



TYPE OF ROOF 

(0) NONE 

(1) SOLID 

(2) T-TOP CLOSED 

(3) T-TOP OPEN 

(4) SUN ROOF CLOSED 

(5) SUN ROOF OPEN 

(6) CONVERTIBLE CLOSED 

(7) CONVERTIBLE OPEN 

(8) OTHER: 



(9) UNKNOWN 



i 



66 



a 



67 



_8_ 

66 



o 



71 



O 



72 



73 



WHEELBASE (cm) 
(999) Unknown 



253?. 

74 75 76 



PLASTIC ANTI-LACERATIVE 
INNER LAYER GLASS EQUIPPED 



(0) NONE 

(1) WINDSHIELD 

(2) WINDSHIELD AND SIDE 
(7) OTHER 

(9) UNKNOWN 



O 

77 



FIELD INVESTIGATOR INSTRUCTIONS: 

1. INDICATE CRUSHED AREAS BY QUh 
LINING NEW PERIMETER OF VEHICLE 

AND SHADING THF DAMAGED AREAS ON 
THE LARGE SKETCH ON PAGE VD-3. 
USE AS MANY SKETCHES AS NECESSARY 
TO COMPLETELY DESCRIBE THE DAMAGE. 

2. ENTER THE DIMENSIONS ON THE 
SKETCH(ES) MEASURED TO THE POINT 
OF MAXIMUM PENETRATION BY THE 
OBJECT(S) CONTACTED, USE THE 
EXAMPLES BELOW AS A GUIDE. 

3. ENTER THE THREE DIMENSIONS TO THE 
CENTER OF THE WHEELS (WHEELBASE, 
FRONT AND REAR OVERHANGS) ON BOTH 
SIDES OF THE CAR. 

4. ADD OTHER DIMENSIONS AS NECESSARY 
TO COMPLETELY DESCRIBE THE DAMAGE. 

EXAMPLES: 



FRONT OR REAR 



^ffih* 



i i 



I ^ -<tkm*t 






'U 

1 1 1 


i 



ROOF (REFERENCE TO 

TOR OF DOOR StU. 
OR WINDOW SILL) 



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from the previous card. 9 10 11 12 



Vehicle Description VD-3 



Wheelbase 

Curb Weight 



_Z___kg 
Average Track Width / 7 ^ cm 

13 15 

Overall Length ^ V / 



ORIGINAL SPECIFICATIONS 



cm 



16 



Overall Width (OAW) 



-/jz_o 



cm 



cm 



19 



21 



Front Overhang 

Rear Overhang 

Undeformed End Width (UEW) __. ~_ __. cm 

Engine Displacement _^ . __. L 

31 a 

Engine: # of Cylinders __? _&. 



22 24 

_ / __"cm 

25 27 

28 30 

_.A 



33 



VEHICLE DAMAGE 




I2SO 








FRONTAL CRASH OVERLAP 



Round up for .5. 98 = 98% or more 
Enter % overlap or "99" for missing or N/A. 

Front-End Overlap (Percent) = DDL 

UEW 



Direct Damage Length (DDL) .O .2- £_ cm 

35 37 

57 % 



JZk. 



• so 



38 39 



Vehicle Overlap (Percent) = DDL + 1/2 fOAW - UEW 7k *" Vt (| "70 -tSO) S~ ' ( ' * 

no 



OAW 



40 41 



10 



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Duplicate columns 1-8 Module JL _£_ Format _£ 2_ 

from the previous card. 9 10 11 12 


Damage DA-1 


Primary 
event number 


CASE VEHICLE PRIMARY CDC 


CONTACTED VEHICLE ASSOCIATED CDC 


1 


\fEH-Q 


IMPACT SPEED (kmm) 


13 ** 

Ml 

14 15 16 

/ 


J31 

35 36 37 


ESTIMATED BY 


f 


CRUSH (cm) 


(6 19 19 20 


Jit 

39 40 41 


CDC#1 


21 27 


42 46 


CDC #2 


3L .o&o j?-° 

28 34 


49 55 


Duplicate columns 1-8 Module _D_ _A_ Format _Q 2_ 

from the previous card. 9 10 11 12 




Secondary 
event number 


CASE VEHICLE SECONDARY CDC 


CONTACTED VEHICLE ASSOCIATED CDC 


13 




IMPACT SPEED (km*) 


14 15 16 


35 36 37 


ESTIMATED BY 


17 


38 


CRUSH (cm) 


18 19 20 


39 40 41 


CDC#1 


21 27 


42 48 


CDC #2 


28 34 


49 55 


Codes 






EVENT NUMBER 


IMPACT SPEED ESTIMATOR 


CRUSH 


(8) NOT APPLICABL 

(9) UNKNOWN 

IMPACT SPEED 

(998) NOTAPPUCA 

(999) UNKNOWN 


.E (1) INVESTIGATOR 

(2) DRIVER 

(3) POLICE 

(4) •CRASH* PROGRAM 

(5) OTHER COMPUTER PROGRAM 
BLE SPECIFY: 

(7) OTHER: 


(998) NOT APPLICABLE 

(NO VEHICLE/DAMAGE) 

(999) UNKNOWN 

CDC 

(9800000) NOT APPLICABLE 
(9900000) UNKNOWN 


(8) NOT APPLICABLE 
(NO VEHICL&NO IMPACT) 



11 



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from the previous card. 9 10 11 12 



Damage DA-2 



Maximum Sheet Metal Crush 

(cm) (999) UNKNOWN 



FRONT 3 Q 

13 IS 

REAR _C?OG_ 

19 21 

ROOF OOO 



RIGHT SIDE & ^O 

16 It 

LEFTSIDE O O O 

22 24 

Ooo 



24 



OTHER 



25 



27 



28 



30 



Chronological Sequence 

of Damage/Injury Producing Crash Events 

for Case Vehicle 



NOTE: IF CHRONOLOGICAL ORDER 
IS UNKNOWN, EVENT 
ORDER IS OPTIONAL 



DO YOU KNOW THIS TABLE i 

TO BE IN CHRONOLOGICAL ORDER? _L 



(0) NO 

(1) YES 



31 



EVENT 
NUMBER 



IMPACT LOCATION 

(1) ON ROADWAY 

(2) SHOULDER/MEDIAN/GORE 

(3) ON ROADSIDE 

(4) OUTSIDE ROADSIDE 



IMPACT 
CONFIGURATION 

FOR CODES, SEE TABLE 
ONPAGEDA-3. 





RIGHT-OF-WAY 

(5) OTHER 

(6) OFF ROADWAY. LOC. UNK. 
(9) UNKNOWN 




#1 


1 

32 


13 

34 


#2 


37 


39 


#3 


42 


44 


#4 


47 


49 


#5 


52 


54 


#6 


57 


59 


#7 


62 


64 



OBJECT/VEHICLE 
CONTACTED 

FOR CODES, SEE TABLE 
ONPAGEDA-4. 



»2 



36 



51 



56 



61 



66 



12 



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Damage DA-3 



CODES FOR 

IMPACT CONFIGURATION 



FRONT OF CASE VEHICLE 

(11) AND EBQHI OF CONTACTED VEHICLE 

(13) AND SIDE OF CONTACTED VEHICLE 

(14) AND REAR OF CONTACTED VEHICLE 

(16) EMQSWEED BY CONTACTED VEHICLE 

(17) AND QBJECI 

(19) AND UNKNOWN OTHER VEHICLE CONFIGURATION 



LEFT SIDE OF CASE VEHICLE 

(21 ) AND FRONT OF CONTACTED VEHICLE (TYPE T) 

(22) AND FRONT OF CONTACTED VEHICLE (TYPE L) 

(23) AND SIDE OF CONTACTED VEHICLE (NOT SIDESWIPE) 

(24) AND REAR OF CONTACTED VEHICLE (TYPE T) 

(25) AND REAR OF CONTACTED VEHICLE (TYPE L) 

(26) SIDESWIPED BY CONTACTED VEHICLE 

(27) ANDQBJEd 

(29) AND UNKNOWN OTHER VEHICLE CONFIGURATION 



REAR OF CASE VEHICLE 

(31 ) AND FRONT OF CONTACTED VEHICLE 

(33) AND SIDE OF CONTACTED VEHICLE 

(34) AND BEAB OF CONTACTED VEHICLE 

(36) FNDSWIPED BY CONTACTED VEHICLE 

(37) ANDQBJEd 

(39) AND UNKNOWN OTHER VEHICLE CONFIGURATION 



RIGHT SIDE OF CASE VEHICLE 

(41 ) AND FRONT OF CONTACTED VEHICLE (TYPE T) 

(42) AND FRONT OF CONTACTED VEHICLE (TYPE L) 

(43) AND SIDE OF CONTACTED VEHICLE (NOT SIDESWIPE) 

(44) AND REAR OF CONTACTED VEHICLE (TYPE T) 

(45) AND REAR OF CONTACTED VEHICLE (TYPE L) 

(46) SIDESWIPED BY CONTACTED VEHICLE 

(47) ANDQBJECI 

(49) AND UNKNOWN OTHER VEHICLE CONFIGURATION 



OTHER 

(57) VEHICLE TO OBJECT 

(58) VEHICLE TO VEHICLE 

(59) VEHICLE TO VEHICLE, CONFIGURATION UNKNOWN 



ROLLOVER 

(61) LESS THAN 360° 

(62) 360° OR MORE 
(69) DETAILS UNKNOWN 



UNKNOWN 

(99) IMPACT TYPE UUKMMU 



13 



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Damage DA-4 



CODES FOR VEHICLE/OBJECT CONTACTED 



VEHICLE/OBJECT GROUPS 

(00) NO OBJECT 

(01) - (39) PASSENGER VEHICLE & TRUCK 
(40) - (69) OTHER VEHICLE 

(70) -(76) PEDESTRIAN &ON-ROADWAY OBJECT 
(77) - (97) OFF-ROADWAY OBJECT 



(98) 
(99) 



OTHER (DESCRIBE) 
UNKNOWN 



PASSENGER VEHICLE 

(02) LARGE 

(03) LIMOUSINE 
(17) PICKUP 

(20) UNKNOWN PASSENGER VEHICLE BODY 

(24) SUB-MINI 

(25) MINI 

(26) SUB-COMPACT 

(27) COMPACT 

(28) INTERMEDIATE 

(29) FULL 



SIZE 

SUB-MINI 

MINI 

SUB-COMPACT 

COMPACT 

INTERMEDIATE 

FULL 

LARGE 

LIMOUSINE 



WHEELBASP 

< 2286 mm (<90*) 
2286 -2412 mm (90*. 94^*) 
2413-2539mm (95* -99.9*) 
2540-2666 mm ( 1 0CT - 104.9*) 
2667-2793mm (105*- 109.9*) 
2794 -2920 mm (110**114.9*) 
2921 - 3174 mm (115* ■ 124.9") 
> 3175 mm ( > 125*) 



MULTIPURPOSE PASSENGER VEHICLE 

(11) SMALL VAN (MINI) 

(12) PICKUP 

(14) SMALL UTILITY (WHEELBASE LESS THAN IQT. 

EG. JEEP. BRONCO) 

(15) LARGE UTILITY (WHEELBASE MORE THAN 10T. 

EG. PANEL TRUCK SUBURBAN) 

(16) PICKUP TRUCK with canopy/shell cover 

(17) PICKUP CAR WITH CANOPY/SHELL COVER 

(21) MOTOR HOME 

(22) PICKUP TRUCK WITH SUDE-IN CAMPER 

(23) PICKUP CAR with sude-in camper 
(31) CHASSIS-MOUNTED CAMPER 



TRUCK 

(1 1 ) SMALL VAN (EG. ECONOUNE) 

(12) PICKUP TRUCK 

(13) UNKNOWN LIGHT TRUCK 

(15) LARGE UTILITY (EG. PANEL TRUCK, SUBURBAN) 

(16) PICKUP TRUCK WITH CANOPY/SHELL COVER 
(22) PICKUP TRUCK WITH SUOE-IN CAMPER 

(30) UNKNOWN TRUCK TYPE 

(31) CHASSIS-MOUNTED CAMPER 

(33) DELIVERY VAN (WALK-IN) 

(34) STRAIGHT TRUCK 

(35) TRUCK-TRACTOR (BOBTAIL) 

(36) CHASSIS-CAB 

(37) UNKNOWN HEAVY TRUCK 

(38) TRACTOR & SEMI-TRAILER (SEMI) 

(39) TRUCK (OR SEMI) & FULL TRAILER^; 



BUS 

(40) UNKNOWN BUS TYPE 

(41) SCHOOL BUS 

(42) INTERCITY BUS (BETWEEN CITIES) 

(43) TRANSIT BUS ONTRACrm 

(44) STREETCAR (on tracks) 



MOTORCYCLE 

(50) UNKNOWN MOTORCYCLE TYPE 

(51) 1-75CC 

(52) 76-125CC 

(53) 126- 250 cc 

(54) 251-SOOcc 

(55) 501 -750 cc 

(56) 751 cc + 

(57) 3WHEELS (OR WITH SIDECAR) 

SPECIAL PURPOSE VEHICLE 

(60) UNKNOWN/OTHER SPECIAL VEHICLE (DESCRIBE) 

(61) SNOWMOBILE 

(62) ATV (ALL TERRAIN VEHICLE) 

(63) AMPHIBIOUS VEHICLE 

(64) FARM VEHICLE 

(65) CONSTRUCTION VEHICLE 

(66) TRAILER. PRIVATE (CAMPER) 

(67) TRAILER, COMMERCIAL (CARGO) 

(68) TRAIN (CARS) 

(69) LOCOMOTIVE (ENGINE. SWITCHER) 



OBJECT 

(70) PEDESTRIAN 

(71) BICYCLIST. OTHER PEDALCYCUST 

(72) PEDESTRIAN CONVEYANCE (EG. PERSON RIDING 
ANIMAL CART) 

LARGE ANIMAL 

FALLEN OBJECT (EG. OBJECT DISLODGED FROM 

OTHER VEHICLE FALLEN TREE ROCKS) 
ROCKS 

(76) CONSTRUCTION EQUIPMENT (EXCLUDING (65)) 

(77) SIGN POST, UTILITY POLE, TREE. . 

(78) DITCH 

(79) EMBANKMENT, SNOWBANK, RR TRACKS RR X 

(80) GROUND (ROLLOVER ONLY) 

(61) CURB (DAMAGE PRODUCING IMPACTS ONLY) 

(82) CULVERT 

(83) FENCE 

(84) HYDRANT, SHORT POST. STUMP 

(85) SMALL POST/TREE, RURAL MAIL BOX, MILE 
MARKER, DELINEATOR 

BUILDING 

PIER, PILLAR, BRIDGE SUPPORT 

(88) ABUTMENT, RETAINING WALL 

(89) BRIDGE RAIL 

(90) GUARD RAIL, LEADING SECTION 

(91) GUARD RAIL. MIDDLE OR UNKNOWN 

(92) GUARD RAIL, TRAILING SECTION 

(93) GUARD POST (TIMBER. METAL CONCRETE) 

(94) CABLE, FENCE BARRIER 

(95) CONCRETE BARRIER (MEDIAN) 

(96) IMPACT ATTENUATOR 

(97) BREAKAWAY FEATURES 



(73) 
(74) 

(75) 



(86) 
(87) 



14 



15 



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from the previous card. 9 10 11 12 



Crash Reconstruction CR-1 

forAV 



EVENT NUMBER 

AV (kmfo) TOTAL 

LONGITUDINAL* 
LATERAL* 

'NOTE: THESE AV COMPONENTS 
MUST INCLUDE SIGN. 

EXAMPLES: 10kmfa*±QlQ 
~7kmfa= z QQZ 



ENERGY DISSIPATED BY 
CRUSH 00 



RECONSTRUCTION 

(01) RECONSTRUCTED, UNKNOWN 
CONFIDENCE LEVEL 

(21) RECONSTRUCTED. LOW 
CONFIDENCE LEVEL 

(22) RECONSTRUCTED. MODERATE 
CONFIDENCE LEVEL 

(23) RECONSTRUCTED, HIGH 
CONFIDENCE LEVEL 

NOT RECONSTRUCTED BECAUSE 

(02) INSUFFICIENT DATA 

(03) EXCESSIVE UNDERRIDE/ 
OVERRIDE 

(04) ROLLOVER 

(05) VAULTING 

(06) OTHER TRAVEL IN MORE 
THAN ONE PLANE 

(07) NON-HORIZONTAL FORCE 

(08) SIDESWIPE-TYPE DAMAGE 

(09) YIELDING OBJECT 

(10) OTHER: 

(11) AT LEAST ONE VEHICLE 
BEYOND SCOPE 

(12) OTHER VEHICLE NOT 
INSPECTED 



MODE 



(1) CDC ONLY 

(2) CDC & DETAILED DAMAGE 

(3) TRAJECTORY & CDC 

(4) TRAJECTORY & CDC & 
DETAILED DAMAGE 

(5) NOT RECONSTRUCTED 

COMPUTER PROGRAM 
SPECIFY: 



16 



CASE VEHICLE PRIMARY IMPACT 



CASE 

VEHICLE 



/ 



13 




CONTACTED 
VEHICLE 



20 



21 



24 



LZ 

29 30 



32 33 34 

fir - 

5 

9- 



CASE VEHICLE SECONDARY IMPACT 



CASE I CONTACTED 

VEHICLE I VEHICLE 



47 



36 



42 



JL 



43 



46 



46 49 50 



51 



55 



56 



59 



62 



66 67 66 



72 



73 



77 



80 



J 



31 



63 



65 



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Duplicate columns 1-8 Module „£ EL Format _Q 2_ 

from the previous card. 9 10 11 12 


Crash Reconstruction CR-2 

for EBS 


EVENT NUMBER 


CASE VEHICLE PRIMARY IMPACT- 


CASE VEHICLE SECONDARY IMPACT 


CASE 
VEHICLE 


i CONTACTED 
1 VEHICLE 


CASE i CONTACTED 
VEHICLE VEHICLE 


13 




47 




EBS (kmto) TOTAL 


O 2 O 

14 15 16 


1~_ 

32 33 34 


48 49 50 


66 67 66 


LONGITUDINAL* 


' O20 


9- — 






17 20 


35 38 


51 54 


69 72 


LATERAL* 

'NOTE: THESE EBS COMPONENTS 
MUST INCLUDE SIGN. 


21 24 


39 42 


«~ 56 


73 76 


EXAMPLES: 10km/h=±Q±Q 
'7kmfa*zQQZ 










ENERGY DISSIPATED BY 
CRUSH w 


25 28 


43 46 


59 62 


77 60 


RECONSTRUCTION 










(01) RECONSTRUCTED, UNKNOWN 
CONFIDENCE LEVEL 


2Z 








(21) RECONSTRUCTED, LOW 
CONFIDENCE LEVEL 

(22) RECONSTRUCTED, MODERATE 
CONFIDENCE LEVEL 

(23) RECONSTRUCTED, HIGH 
CONFIDENCE LEVEL 


29 30 

I 3 *t* 




63 64 




NOT RECONSTRUCTED BECAUSE 


" /2 J 








(02) INSUFFICIENT DATA 

(03) EXCESSIVE UNDERRIDE/ 
OVERRIDE 

(04) ROLLOVER 

(05) VAULTING 

(06) OTHER TRAVEL IN MORE 
THAN ONE PLANE 

(07) NON-HORIZONTAL FORCE 

(08) SIDESWIPE-TYPE DAMAGE 

(09) YIELDING OBJECT 
M0> OTHER: 








(1 1 ) AT LEAST ONE VEHICLE 
BEYOND SCOPE 

(12) OTHER VEHICLE NOT 
INSPECTED 


MODE 










(1) CDC ONLY 

(2) CDC & DETAILED DAMAGE 

(3) TRAJECTORY & CDC 

(4) TRAJECTORY & CDC & 
DETAILED DAMAGE 

(5) NOT RECONSTRUCTED 


2 

31 




65 




COMPUTER PROGRAM 
SPECIFY: «*"•'* CM* I* 











17 



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Duplicate columns 1-8 
from the previous card. 



Module J2 &_ Format J2 a» 

9 10 11 12 



Crash Reconstruction CR-3 



WOTES: T. 5VTEB CRASH RECONSTRUCTION DAMAGE MEASUREMENTS IN CENTIMFTFPS 

2. MEASURE C j TO C 6 FROM DRIVER TO PASSENGER SIDE IN FRONT OR REAR 
IMPACTS, REAR TO FRONT IN SIDE IMPACTS. 



3. D IS POSITIVE IF MEASURED TO A POINT FORWARD OF OR TO THE RIGHT OF THE CG. 

4. USE THE CENTER OF THE WHEELBASE AS THE CG. 

Locate the end of the damage with respect to the vehicle longitudinal center line, or an undamaged axle for side impacts. 



Case Vehicle 
locator 



Specific Impact No. 



Location of Direct Damage 



Location of Field L 



i 



7Lcfv\ - -"Rect/os at I Botwoi=g CoRft/e<e 



fctC^- FftORrr^oiwPfcetro ~~jgcsA*ee&~ 



stze -- \ 

(*/€ /Mr "/oct - 



Coi?rvJEft 



Co£*set£ 



PLANE: 

(1) Bumper 

(2) Above Bumper 

(3) Sill 

(4) Above SW 

(5) Other 




c a a 



/HAY crust* *J 




4f C</ 7t>fA#0* Cs 

UDL 



Specific 
Impact 
Number 



(9) Unknown CRUSH PROFILE IN CENTIMETERS 

NOTE: Each line in the table below is a separate record (card). Duplicate columns 1 - 12 for each completed line. 



Plane | 
of Impact 
C-Measur. 



Direct Damage 



Length 
(DDL) 



7* 



Max 

Crush 



Field 

L 



I 



'1 



C 2 J C 3 



3Q i I3(> \0 fe lo.S- 



l-2-l H 



c 4 



IfL 



2% 



IG.< 



13 I 



076 03% lit ooo OOP Ci/t 



15 16 17 I 18 19 20 21 22 23 i 24 25 26 ! 27 28 29 I 30 31 32 



I 



I 



/* 



C 5 



IX 



*L 



IS 



0/9 



33 34 35 



O/S* 



36 37 38 



C 6 



11 



/?_ 



oo7 



39 40 41 



±D 



'37 



+037 



42 43 44 45 



18 



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Duplicate columns 1-8 Module^ JEL Format JL _4_ CRASH RECONSTRUCTION CR-4 
from the previous card. 9 10 11 12 


NOTTS 1. ENTER CRASH RECONSTRUCTION DAMAGE MEASUREMENTS IN CENTIMETERS 

Other Vehicle 

2. MEASURE C f TO C 6 FROM DRIVER TO PASSENGER SIDE IN FRONT OR REAR 
IMPACTS. REAR TO FRONT IN SIDE IMPACTS. 

LOCATOR 

3. D IS POSTTIVE IF MEASURED TO A POINT FORWARD OF ORTOTHE RIGHT OF THE CG. 

4. USE THE CENTER OF THE WHEELBASE AS THE CG. 

Locate the end of the damage with respect to the vehicle longitudinal center line, or an undamaged axle for side impacts. 


Specific Impact No. 


Location of Direct Damage 


Location of Field L 




















PLANE: 

(1) Bumper 

(2) Above Bumper 

(3) Sill 

(4) Above Sill 






C C2 C3 




f x 


C6 
C6 


/G& 


i 


/L. I \ C2 


i 

• 
en 


DL 
UDL 










/M 


C1 


/ 






(5) Other 












(9) Unknown CRUSH PROFILE IN CENTIMETERS 
NOTE: Each line in the table below is a separate record (card). Duplicate columns 1 - 12 for each completed line. 


Specific i Plane 
impact | of Impact 
Number I C-Measur. 


Direct Damaae 




Ci 


Cg 


C3 


c 4 


c 5 


c 6 


±D 


Length 
(DDL) 


Max 
Crush 


Field 
L 


























































































































1 


? 


19* 


99? 


?9? 


fff 


9 99 


9 99 


fff 


9ff 


999 


*999 


13 14 


15 16 17 


18 19 20 > 21 22 23 


24 25 26 


27 28 29 | 30 31 32 


33 34 35 


36 37 38 


39 40 41 


42 43 44 45 


i 










| 
















1 






















































































2 

























19 



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Duplicate columns 1-6 
from the previous card. 



Module _ffi_ J. Format JL _L 

9 10 11 12 



Wheels and Tires WT-1 



WHEELS-DAMAGED 



(0) NO 

(1) YES 

(9) UNKNOWN 



TIRE TREAD TYPE 

(1) REGULAR 

(2) SNOW 

(3) SUCKS 

(4) ALL WEATHER (MS) 
(7) OTHER: 



(9) UNKNOWN 



LF 



.0 



13 



RF 


0. 


RR 


Q_ 


LR 


o_ 




16 


LF 


JL 




17 


RF 


jL 


RR 


X 


LR 


£ 



20 



tRCASS CONSTRUCTION 


LF 


3 


(1) BIAS 




21 

3 


(2) BELTED BIAS 


RF 


(3) RADIAL 






(4) ELLIPTICAL 




3 


(5) HI PRESSURE SPARE 


RR 


(6) SPACE SAVER SPARE 






(7) OTHER: 


LR 


^_ 


(9) UNKNOWN 



24 



IF VEHICLE IS EQUIPPED WITH DUAL 
WHEELS, COMPLETE FOR OUTER WHEELS 
AND MAKE NOTES ON INNER WHEELS. 

NOTES: 



SIZE (NOT DOT CODE. IF UNKNOWN, USE 9'S) 



RF 



RR 



LR 



45 



55 



20 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module JL. JL. Format JL -J. FUEL AND FUEL TANKS i 


FT-1 


from the previous card. 9 10 11 12 




TYPE OF PROPULSIVE FUEL 


_/ 


AUXILIARY TANK TYPE 


: 2 


(1) GASOLINE 


(1) OEM TANK 


(2) DIESEL OIL 


13 


(2) AFTER MARKET TANK 


21 


(3) LPG 




(8) NOT APPLICABLE (NOT EQUIPPED) 




(4) ELECTRIC 




(9) UNKNOWN 




(7) OTHER: 








(9) UNKNOWN 








MAIN TANK LOCATION 


322 


AUXILIARY TANK LOCATION 


2£k 




14 16 




22 24 


MAIN FILLER CAP LOCATION 


1Q- 


AUXILIARY FILLER CAP LOCATION 


fl* 




17 19 




25 27 


MAIN TANK MATERIAL 


I 

20 


AUXILIARY TANK MATERIAL 


2B 


TANK AND FILLER CAP LOCATION CODES 




FIRST DIGIT (LONGITUDINAL) 




(1) BEHIND KICK-UP 




(2) IN KICK-UP 




(3) BETWEEN KICK-UP & COWL 




(4) FORWARD OF COWL 




(8) NOT APPLICABLE f/VOTEOl//PPED; 




(9) UNKNOWN 




SECOND DIGIT (LATERAL) 




(1) LEFT OF FRAME 




(2) WITHIN FRAME OR CENTERED 




(3) RIGHT OF FRAME 




(4) DUAL. RIGHT & LEFT TANKS 




(8) NOT APPLICABLE 0V/OTEQU/PPED; 




(9) UNKNOWN 




THIRD DIGIT (VERTICAL) 




(1) BELOW FRAME 




(2) WITHIN FRAME OR CENTERED 




(3) ABOVE FRAME 




(8) NOT APPLICABLE (NOT EQUIPPED) 




(9) UNKNOWN 




TANK MATERIAL CODES 




(1) STEEL 




(2) ALUMINUM 




(3) PLASTIC 




(7) OTHER 




(8) NOT APPLICABLE (NOT EQUIPPED) 




(9) UNKNOWN 





21 



BEST AVAILABLE COPY 



Duplicate columns 1-6 
from the previous card. 



Module _E L. Format Jl 1_ 

9 10 11 12 



Fuel Leakage FL-1 



DID FUEL LEAKAGE RESULT FROM A CRASH EVENT 

(0) NO KNOWN LEAKAGE SHE PAGE. 

(1) YES COMPLETE PAGE. 







13 



LEAK 
NUMBER 



#1 
#2 
#3 
#4 
#5 



I 



LEAKING 
COMPONENT 



14 15 



22 23 



30 31 



38 39 



46 47 



COMPONENT 
SOURCE 



TYPE OF 
DAMAGE 



IV 



SEVERITY 
OF DAMAGE 



V 



LOCATION 
OF LEAK 



EVENT 
NUMBER 



21 



29 



37 



45 



53 



LEAKING COMPONENT 



TANK AREA 

(11) MAIN FUEL TANK (INCLUDING 

VAPOR RECOVERY DOME) 

(12) AUXILIARY FUEL TANK 

(13) MAIN TANK FILLER TUBE 

(14) MAIN TANK CAP (GAS CAP) 

(15) AUXILIARY TANK FILLER TUBE 

(16) AUXILIARY TANK CAP (GAS CAP) 
(19) TANK AREA. DETAILS UNKNOWN 



DELIVERY SYSTEM 

(21) FUEL FEED UNE (MAIN TANK 
TO FUEL PUMP) 

(22) FUEL FEED UNE (AUXIUARY 
TANK TO FUEL PUMP) 

(23) FUEL RETURN UNE (FUEL 
PUMP TO TANK) 

(24) INUNE FUEL FILTER 

(25) FUEL UNE (PUMP TO 
CARBURETOR OR INJECTOR PUMP) 

(26) CARBURETOR TO INJECTOR PUMP 

(27) FUEL PUMP 

(29) DEUVERY SYSTEM, DETAILS 
UNKNOWN 



EVAPORATIVE EMISSION CONTROL SYSTEM 

(31) ATMOSPHERIC VENT PIPE 
(NON-EEC EQUIPPED) 

(32) EEC PIPE (VAPOR CANISTER 

TO CARBURETOR) 



EEC SYSTEM (CONTINUED) 

(33) VAPOR RECOVERY HOSES 
(CANISTER TO CARBURETOR) 

(34) UOUID-VAPOR SEPARATOR 

(UNLESS PART OF TANK) 

(35) CANISTER 

(39) EEC SYSTEM. DETAILS 
UNKNOWN 



IV SEVERITY OF DAMAGE 



(1) MINOR 

(2) MODERATE 

(3) SEVERE 

(4) DISCONNECTED/DEFEATED 
(9) UNKNOWN 

V LOCATION OF LEAK 

FIRST DIGIT 
(LONGITUDINAL LOCATION) 



II 



III 



(49) ENGINE COMPARTMENT. 




COMPONENT UNKNOWN 


(1) F, FORWARD OF COWL 


(99) COMPONENT UNKNOWN 


(2) P. BETWEEN COWL & 




REAR BULKHEAD 




(3) B. BEHIND REAR BULKHEAD 




(4) Y. F. & P 


COMPONENT SOURCE 


(5) Z. P. & B 




(6) D. DISTRIBUTED 


(1) OEM 


(F.PAB) 


(2) AFTER MARKET 


(9) UNKNOWN 


(9) UNKNOWN 






SECOND DIGIT 




(LATERAL LOCATION) 


TYPE OF DAMAGE 






(1) LLEFT 


(1) DENTED/CRUSHED 


(2) C, CENTER 


(2) PUNCTURED 


(3) R, RIGHT 


(3) RUPTURED 


(4) Y. LEFT CENTERS AC) 


(4) SEVERED/GROSS TEARS 


(5) Z, RIGHT CENTER (R A C) 


(5) DISCONNECTED/DEFEATED 


(6) D, DISTRIBUTED 


(9) UNKNOWN 


(F,P&B) 




(9) UNKNOWN 



22 



BEST AVAILABLE COPY 



Duplicate columns 1*8 
from the previous card. 



Module _E_ -JL Format JL JL 

9 10 11 12 



Fire FR-1 



WAS THERE FIRE IN OR ON CASE VEHICLE? 

(0) NO SKIP PAGE. 

(1) YES COMPLETE PAGE. 



o 



13 



DID FIRE START IN CASE VEHICLE? 

(0) NO 

(1) YES 

(9) UNKNOWN 



FLAME PROROGATION RATE 



(1) RAPID/EXPLOSIVE 

(2) SLOW/MODERATE 
(9) UNKNOWN 



SEVERITY OF FIRE DAMAGE 

(1) MINOR 

(2) MODERATE 

(3) SEVERE 
(9) UNKNOWN 



DID AN INJURY TO CASE 

VEHICLE OCCUPANT RESULT FROM 

FIRE IN OR ON CASE VEHICLE? 

(0) NO 

(1) YES 

(9) UNKNOWN 



16 



17 



PROVIDE NOTES IF FIRE OCCURRED. 



23 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module J= £L Format JQ 1 

from the previous card. 9 10 u 12 



Exterior Damage 



ED-1 



Hood Performance 



FOR THE FOLLOWING, USE CODES: 



(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 



HOOD LATCHfES> 



HOOD HINGES- 



-RELEASED 
-DAMAGED 
-JAMMED 

-LEFT, DAMAGED 



-LEFT, SEPARATED 

(COMPLETE) 

-RIGHT, DAMAGED 



-RIGHT, SEPARATED 
(COMPLETE) 



HOOD REMAINED ON VEHICLE 



REAR EDGE OF HOOD- 



-ELEVATED 



-CONTACTED WINDSHIELD 



-PENETRATED WINDSHIELD 



HOOD LATCH LOCATION 

(1) FRONT OF VEHICLE 

(2) COWL AREA 

(3) SIDE 

(8) NOT APPLICABLE 

(9) UNKNOWN 



Engine or Transmission Mount 

SEPARATION (COMPLETE) 

(0) NO 

(1) YES 

(9) UNKNOWN 





13 

£> 

14 

3 

15 
16 

% 

17 


\ 

19 

J 

20 

J 

21 



22 

3 



23 



I 



24 







25 



Steering Col Flexible Coupling 



FLEXIBLE COUPLING TYPE 



(0) 
(D 
(2) 
(3) 
(4) 
(5) 
(6) 



NONE 

FLEXIBLE MATERIAL 
POT 

SINGLE U-JOINT 

DOUBLE U-JOINT 

FLEXIBLE CABLE 

COMBINATION OF ABOVE 

(CIRCLE EACH) 

(7) OTHER:. 



.9 

26 



(8) EQUIPPED. TYPE UNKNOWN 

(9) UNKNOWN, IF EQUIPPED 



COUPLING- 

(USE CODES 
FROM HOOD 
PERFORMANCE) 



-DAMAGED 



-SEPARATED 
(COMPLETE) 



9. 

27 

9. 

28 



Eng Compart Telescoping Unit 

TYPE OF UNIT 

(00) NONE INSTALLED 

(01) - (07) SEE UNITS ON PAGE ED-2 
(88) NOT COLLECTED 

(97) OTHER: 

(98) EQUIPPED. TYPE UNKNOWN 

(99) UNKNOWN IF EQUIPPED 



ORIGINAL LENGTH (mm) 
f(ORH): 



TELESCOPED LENGTH (mm) 
G: 



DIFFERENCE (mm) 
F(ORH)-G 
(IF LESS THAN 15mm, ENTER '000'.) 

(888) NOT COLLECTED 

(991) NOT MEASURED/NO 
COMPRESSION 

(992) COMPRESSED. AMOUNT 
UNKNOWN 

(993) DEVICE EXTENDED 

(997) UNABLE TO BE MEASURED 

(998) NOT APPLICABLE (NOT 
EQUIPPED) 

(999) UNKNOWN 



8 8 

29 30 



8_JB JJ 

31 33 



24 



BEST AVAILABLE COPY 



Exterior Damage 



ED-2 



Left-Side Body Mount 
did body mount separate? 

(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 



Left Pillars 
pillars separated completely - 
use codes: 

(0) NO 

(1) YES 

(4) NO SEPARATION, BUT DAMAGED 

(8) NOT APPLICABLE (NOT EOI//PPED; 

(9) UNKNOWN 

-A-PILLAR, UPPER 



LOWER 



-B-PILLAR, UPPER 



LOWER 



-C-PILLAR, UPPER 



LOWER 



-D-PILLAR, UPPER 



LOWER 



* 



o 

35 



36 

o 

37 
38 

o 

39 



40 

% 

41 



Left Doors 

how did doors 

open during collision? 

USE CODES: 

(0) DOOR DID NOT OPEN 
OPENED BECAUSE OF 

(1) HINGE AREA SEPARATION 

(2) DOOR-LATCH SEPARATION 

(3) LATCH-STRIKER SEPARATION 

(4) STRIKER-PILLAR SEPARATION 

(5) BODY DISTORTION 

(6) COMBINATION OF ABOVE 
(CIRCLE EACH) 

(7) OPENED. REASON UNKNOWN 

(8) NOT APPLICABLE (A/O 0OO/J) 

(9) UNKNOWN 



•FRONT 



-REAR 



DOORS JAMMED CLOSED- 
USE CODES: 

(0) NO 

(1) YES 

(8) NOT APPLICABLE (NO DOOR) 

(9) UNKNOWN 



-FRONT 



-REAR 



Q 

43 





o 

45 



25 



BEST AVAILABLE COPY 



Exterior Damage 



ED-3 



Rear Door 
rear door type 

(0) NO DOOR (INCLUDES PICKUPS) 

(1) HATCHBACK 

(2) ONE-WAY TAILGATE 

(3) TWO-WAY TAILGATE 

(4) CLAMSHELL/DISAPPEARING 
TAILGATE 

(5) SINGLE DOOR 

(6) DOUBLE DOOR 
(9) UNKNOWN 



Hatchback 




One-way 



Two-way 



Clamshell 



Single door 



Double door 



^o^ ^ 








HOW DID DOOR 

OPEN DURING COLLISION? 

(0) DOOR DID NOT OPEN 
OPENED BECAUSE OF 

(1) HINGE AREA SEPARATION 

(2) DOOR-LATCH SEPARATION 

(3) LATCH-STRIKER SEPARATION 

(4) STRIKER-PILLAR SEPARATION 

(5) BODY DISTORTION 

(6) COMBINATION OF ABOVE 
(CIRCLE EACH) 

(7) OPENED, REASON UNKNOWN 

(8) NOT APPLICABLE (NO DOOR) 

(9) UNKNOWN 



DOOR JAMMED CLOSED 

(0) NO 

(1) YES 

(8) NOT APPLICABLE (NO DOOR) 

(9) UNKNOWN 



j 



49 



Other Rear Damage 



WAS PARTITION TO LUGGAGE AREA 
DAMAGED DURING COLLISION? 

(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 



SPARE TIRE 

(0) NO SPARE TIRE 

(1) NOT ATTACHED BEFORE COLLISION 

(2) ATTACHED. NOT SEPARATED IN 
COLLISION 

(3) ATTACHED, SEPARATED DUE TO 

COLLISION 

(8) NOT COLLECTED 

(9) UNKNOWN 



TRAILER HITCH TYPE 

(0) NO HITCH 
BALL-AND-SOCKET TYPES 

(1) TEMPORARY FRAMEWORK (EG. 

RENTAL CLAMP-ON) 

(2) BUMPER-MOUNT ONLY (EG. LIGHT 

TRUCK) 

(3) BUMPER-AND-FRAME (BUTNON- 
EQUAUZJNG) 

(4) LOAD EQUALIZING 

OTHER TYPES 

(5) RING-AND-PINTLE 

(6) FIFTH-WHEEL (INCL P/U) 

(7) OTHER (EG. CLEVI&AND-PIN) 



£ 



50 



8_ 

51 



(8) EQUIPPED, TYPE UNKNOWN 

(9) UNKNOWN IF EQUIPPED 



TRAILER TYPE 

(AT TIME OF COLLISION) 

(0) NO TRAILER 

(1) TRAVEL-TRAILER/CAMPER 

(2) MOBILE HOME 

(3) BOAT/SNOWMOBILE/ATV TRAILER 

(4) UTILITY TRAILER 

(5) TOWED CAR 

(7) OTHER: 

(8) TRAILER, TYPE UNKNOWN 

(9) UNKNOWN 



52 



O 



53 



26 



BEST AVAILABLE COPY 







Exterior Damage I 


ED-4 


Right-Side Body Mount 


I 






DID BODY MOUNT SEPARATE? 


? 


Right Doors 




(O) NO 


HOW DID DOORS 




(1) YES 


54 


OPEN DURING COLLISION? 




(8) NOT APPLICABLE 








(9) UNKNOWN 




USE CODES: 

(00) DOOR DID NOT OPEN 








Right Pillars 




OPENED BECAUSE OF 




PILLARS SEPARATED COMPLETELY • 




(01) HINGE AREA SEPARATION 

(02) DOOR-LATCH SEPARATION 




USE CODES: 




(03) LATCH-STRIKER SEPARATION 

(04) STRIKER-PILLAR SEPARATION 




(0) NO 




(05) BODY DISTORTION 




(1) YES 




(06) COMBINATION OP ABOVE 




(4) NO SEPARATION, BUT DAMAGED 




(CIRCLE EACH) 




(8) NOT APPLICABLE (NOT EQUIPPED) 




(07) OPENED, REASON UNKNOWN 




(9) UNKNOWN 




(11) VAN RIGHT-REAR DOOR OPENED 
(ANY MECHANISM) 









(98) NOT APPLICABLE 0VODOO*; 




-A-PILLAR, UPPER 


(99) UNKNOWN 






55 


-FRONT 


QQ 


LOWER 




56 


-REAR 


63 64 

CO 






57 




65 66 


-B-PILLAR, UPPER 











DOORS JAMMED CLOSED- 




LOWER 


USE CODES; 






58 


(0) NO 

(1) YES 









(8) NOT APPLICABLE (NO DOOR) 




-C-PILLAR, UPPER 


(9) UNKNOWN 






59 


-FRONT 





LOWER 


D 




67 




60 


-REAR 


Q 




% 

61 




66 


-D-PILLAR, UPPER 








i 


VAN REAR DOOR TYPE 


$ 


LOWER 


(0) VAN, NO REAR DOOR 




62 


(1 ) TRACK (SUDING) - RIGHT SIDE 

(2) SINGLE-HINGED - RIGHT SIDE 

(3) DOUBLE-HINGED - RIGHT SIDE 

(4) TRACK (SUDING) - RIGHT & LEFT SIDE 

(5) SINGLE-HINGED - RIGHT & LEFT SIDE 

(6) DOUBLE-HINGED - RIGHT & LEFT SIDE 

(7) TRACK AND HINGED COMBINATION 

(8) NOT APPLICABLE (NOT A VAN) 

(9) UNKNOWN 


69 



27 



BEST AVAILABLE COPY 



Exterior Damage 



ED-5 



Windshield Damage 



WINDSHIELD CRACKED 

(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 



WINDSHIELD BROKEN 
(PLASTIC 1NTERLAYER TORN) 

(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 



CRACKED OR BROKEN 
BY OCCUPANT CONTACT 

(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 



EXTENT OF BOND SEPARATION 

(0) NONE 

(1) 1-20% 

(2) 21-40 

(3) 41 - 60 

(4) 61 - 80 

(5) 81 - 99 

(6) TOTAL 

(7) SEPARATED, AMOUNT 
UNKNOWN 

(8) NOT APPLICABLE 

(9) UNKNOWN 



70 



Windshield Mark on case vehicle: 



g o *~ * (£ 



5 



71 



8" 



72 



O 



73 




AJ 



A&t 
7 



tf- 



WINDSHIELD CODE 

(97) DESCRIBED BUT NOT CODED 

(98) NOT APPLICABLE (NO WINDSHIELD) 

(99) UNKNOWN 



Roof 



DID T-ROOF/SUN ROOF OPEN 
DURING COLLISION? 

(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(NOT A T-ROOP OR SUN ROOF) 

(9) UNKNOWN 



74 75 



8 



76 



LOCATE AREA OF WINDSHIELD INTEREST OR DAMAGE WITH DIMENSIONS (VERTICAL 
& HORIZONTAL) ON THIS DIAGRAM OF THE WINDSHIELD AS VIEWED FROM INSIDE. 




28 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module .£ CL Format JQ J_ 

from the previous card. 9 10 11 12 


Steering Wheel and Column ! 


SC-1 


Steering Wheel 


I 
i 


STEERING WHEEL POSITION 
AT TIME OF COLLISION 




STEERING WHEEL RIM DAMAGE 

(0) NONE 

(1) DEFORMED SLIGHTLY 

(2) SEVERELY BENT 

(3) BROKEN 
(9) UNKNOWN 




13 


IN WHAT OCLOCK POSITION WAS THE 
NORMAL TOP OF THE WHEEL POWTED 
WHEN THE COLLISION OCCURRED? 

EXAMPLES 

OCLOCK-XX OTXOCK-.Q..2 




NUMBER OF 

STEERING WHEEL SPOKES 

(9) UNKNOWN 


1 

14 


(NORMAL STRAIGHT 

AHEAD) O'CLOCK • 




STEERING WHL SPOKE DAMAGE 


15 


t99\ UNKNOWN 




Steering Wheel 




(0) NONE 

(1) DEFORMED SLIGHTLY 

(2) SEVERELY BENT 

(3) BROKEN 
(9) UNKNOWN 


Energy Absorbing Device 

4 (1) EXAMPLES: 

jfj+jbt BARRACUDA, 70-74 
j£LsJ$t>+^ CHALLENGER 70-74 
"^^**&) ~Jt CAPRI. 71-77 








\\ \ 

\\ J&. m EXAMPLES: 

S^^ "* . HORBON.n* 




Steering Column Options 




TILT FEATURE 


2 

16 


TYPE OF DEVICE 




(0) NOT EQUIPPED 

(1) YES, EQUIPPED, UNK POSITION 

(2) UP 

(3) MIDDLE 

(4) LOWER 

(9) UNKNOWN IF EQUIPPED 


(0) NONE 

(1) CONVOLUTED OR MESH CYLINDER 

(2) DEEP DISH STEERING WHEEL 
m OTHER: 


8. 

IS 


(8) NOT COLLECTED 

(9) UNKNOWN IF EQUIPPED 






ORIGINAL DIMENSION (mm) 




SWING-AWAY FEATURE 


17 


A: 




(0) NOT EQUIPPED 

(1) YES, EQUIPPED 

(9) UNKNOWN IF EQUIPPED 


DAMAGE DIMENSION (mm) 
B: 








DIFFERENCE (mm) 




TELESCOPING FEATURE 


18 


A-B 




(0) NOT EQUIPPED 

(1) YES. EQUIPPED 

(9) UNKNOWN IF EQUIPPED 


(888) NOT COLLECTED 

(991) NOT MEASURED/NO APPARENT 
COMPRESSION 

(992) COMPRESSED, AMOUNT UNKNOWN 

(993) DEVICE EXTENDED 

(997) UNABLE TO MEASURE 

(998) NOT APPLICABLE (NOT EQUIPPED) 

(999) UNKNOWN 


8 8 8 

20 22 



29 



BEST AVAILABLE COPY 



Steering Wheel and Column SC-2 



Steering Column 
Energy Absorbing Device 
type of device * (if 27 or 28) 

(00) NOT EQUIPPED 
(88) NOT COLLECTED 
(99) UNKNOWN 

ORIGINAL LENGTH (mm) 
C: 

COMPRESSED LENGTH (mm) 
D: 

BRACKET DEFLECTION of code 36, 46, 

OR 49 ABOVE) 

OR 
COMPRESSION (OR EXTRUSION) (mm) 

C - D (OR E) (TOLERANCE' ±10) 

(888) NOT COLLECTED 

(991) NOT MEASURED/NO APPARENT 
COMPRESSION 

(992) COMPRESSED, AMOUNT UNKNOWN 

(993) DEVICE EXTENDED 

(997) UNABLE TO BE MEASURED 

(998) NOT APPLICABLE 0VOrEG(//PFED; 

(999) UNKNOWN 

* (ADD A&B FOR TOTAL COMPRESSION) 
SHEAR CAPSULE SEPARATION (mm) 
S (USEAVG. OF LEFT & RIGHT CAPSULES.) 
LT: 



RT: 




(888) NOT COLLECTED 

(991) NOT MEASURED/NO APPARENT 
SEPARATION 

(992) SEPARATED. AMOUNT UNKNOWN 

(997) UNABLE TO BE MEASURED 

(998) NOT APPLICABLE (NOT EQUIPPED) 

(999) UNKNOWN 



COLUMN VERTICAL ROTATION 

(0) NO APPARENT ROTATION 

(1 ) UPWARD APPARENT ROTATION 

(2) DOWNWARD APPARENT ROTATION 
(9) UNKNOWN 



COLUMN LATERAL ROTATION 

(0) NO APPARENT ROTATION 

(1) LEFT APPARENT ROTATION 

(2) RIGHT APPARENT ROTATION 
(9) UNKNOWN 



23 24 



Steering Wheel (continued) 



STEERING WHEEL HUB DAMAGE 

(0) NONE 

(1) OCCUPANT CONTACT 

(2) AIRBAG 

(3) OTHER 



33 



(9) UNKNOWN 



8 88 

25 27 



8 8^ 8 

28 30 



O 



32 



30 



31 



BEST AVAILABLE COPY 



Intrusion IT-1 


Location of 
Intrusion 


Intruded Component 


(All Measurements Are in Centimeters) 

Comparison Intruded 

Value — Value = intrusion 


Dominant 

Crush 
Direction 






— - 








— s 








— - 








— a 








— = 








— - 








— = 








— - 








— s 








— s 








— - 








— - 








— - 








— - 








— - 








— - 




OCCUPANT CONTACT WORKSHEET 


Contact 


Interior 
Component 
Contacted 


Occupant 

No. if 

Known 


Body 

Region 

if Known 


Supporting Physical Evidence 


Confidence 

Level of 

Contact 

Point 


A 


CotiSeU 


/ 


Kr<*- 


SCu&S* 


j 


B 


C-hitt ffe* 





tt*€$ 


fLuf>r 


/. 


C 


Lovct xp 


/ 


\lfiU 


rcu^p- 


/ 


D 












E 








■ 




F 












G 












H 












I 












J 













32 



BEST AVAILABLE COPY 



Intrusion IT-2 



VEHICLE OCCUPANT CONTACT DIAGRAM 





"Dft *€lt '. op -cos trie aJ 










33 



BEST AVAILABLE COPY 



Intrusion IT-3 



CODES FOR COLUMN B, OCCUPANT SPACE NUMBER 

OCCUPANT SPACE NUMBER IS A TWO-DIGIT CODE. THE USE OF THE CODE IS DETERMINED BY THE VEHICLE 

seat configuration at the time of the accident. 

First Digit 

the first digit (left digit) denotes the seat row, with code values from 1tos. 

Second Digit 

the second digit (right digit) denotes the position on the sea t and, in some instances, 
the width of the seat. 

(1) left (3) right individual seat 

(1) left (2) center (3) right bench: full width 3 passenger 



(1) LEFT (2) LEFT 

CENTER 



(6) RIGHT (3) RIGHT BENCH: FULL WIDTH 4 PASSENGER 

CENTER 



(1) LEFT (2) CENTER (5) RIGHT & BENCH: PARTIAL WIDTH. LEFT 

AISLE SPACE 

(0) LEFT& (2) CENTER (5) RIGHT & BENCH: PARTIAL WIDTH. CENTERED 

SPACE SPACE 

(4) ENTIRE VEHICLE WIDTH 



CARGO AREA 



Examples 

the two figures below provide examples of the occupant space number. 



PASSENGER CAR 
5 PASSENGERS 



VAN 
12 PASSENGER CAPACITY 



X X 

XXX 



11 13 

21 22 23 



X X 

XXX 
XXX 
X X X X 



11 13 

21 22 25 
31 32 35 

41 42 46 43 



CODES FOR COLUMN R MEASUREMENT AXIS 

(X) X-AXIS (FORE & AFT) 
(Y) Y-AXIS (LATERAL) 
(Z) 2-AXIS (VERTICAL) 



CODES FOR COLUMNS G, H , I & J, OCCUPANT & INJURY NUMBERS 



OCCUPANT 


INJURY 


NUMBER 


NUMBER 


(00) 


(00) 


(##) 


(00) 


(97) 


(99) 


(99) 


(00) OR (99) 



CONTACT 

NO CONTACT 

CONTACT. NO INJURY 

CONTACT. OCCUPANT UNKNOWN. INJURY UNKNOWN 

UNKNOWN IF CONTACT 



34 



3>S 



BEST AVAILABLE COPY 



Intrusion IT-4 



CODES FOR COLUMN C, INTRUDING COMPONENT OR OBJECT 



NOTE: DO. M2I CODE OBJECTS OTHER THAN COMPONENTS OF CASE VEHICLE. 



Individual Component 



Grouped for Massive intrusion into an Occupant Space 



INTERNAL 


USE ONLY IF ALL THESE COMPONENTS 




INTRUDED INTO A SINGLE OCCUPANT SPACE. 


(01) INSTRUMENT PANEL 






(02) FIREWALL 


(50)WINDSHIELD HEADER 


(60)ROOF 


(03) TOE PAN 


A-PILLAR 


ROOF RAIL 


(04) FLOOR PAN 


ROOF SIDE RAIL 


A-PILLAR 


(05) STEERING COLUMN 




B-PILLAR 


(06) WINDSHIELD 


(51 INSTRUMENT PANEL 


OPILLAR 


(07) WINDSHIELD HEADER 


A-PILLAR 


WINDOW FRAME 


(08) A-PILLAR 


DOOR PANEL 


DOOR PANEL 


(09) DOOR PANEL OR SIDE PANEL 




FLOOR PAN 


(10) WINDOW FRAME 


(52)INSTRUMENT PANEL 




(11) B-PILLAR 


A-PILLAR 


(61 INSTRUMENT PANEL 


(12) C-PILLAR 


WINDSHIELD HEADER 


TOE PAN 


(13) D-PILLAR 




WINDSHIELD HEADER 


(14) ROOF SIDE RAILS 


(53)DOOR PANEL 


A-PILLAR 


(15) ROOF OR CONVERTIBLE TOP 


B-PILLAR 


ROOF RAIL 


(16) BACKLIGHT HEADER 


ROOF RAIL 


WINDOW FRAME 


(17) FRONT SEAT-BACK SURFACE/ 




DOOR PANEL 


SEAT-BACK BACK SURFACE 


(54)DOOR PANEL 


ROOF 


(18) SECOND SEAT-BACK SURFACE 


A-PILLAR 




SEAT-BACK BACK SURFACE 


ROOF RAIL 


(62)ROOF 


(19) THIRD SEAT-BACK SURFACE 




ROOF RAIL 


SEAT-BACK BACK SURFACE 


(55)INSTRUMENT PANEL 


C-PILLAR 


(20) FOURTH SEAT-BACK SURFACE 


FLOOR PAN 


WINDOW FRAME 


SEAT-BACK BACK SURFACE 


A-PILLAR 


FLOOR PAN 


(21) FIFTH SEAT-BACK SURFACE 


DOORFRAME 


SECOND SEAT 


SEAT-BACK BACK SURFACE 




DOOR PANEL 


(22) BACK PANEUBACK DOOR SURFACE 


(56)ROOF RAIL 




(23) SEAT CUSHION SURFACE/EDGE 


A-PILLAR 


(63)ROOF RAIL 


(24) CONSOLE 


B-PILLAR 


ROOF 


(25) OTHER (DESCRIBE) 


WINDOW FRAME 


B-PILLAR 


(26) UNKNOWN INTERNAL SURFACES 




WINDOW FRAME 


(28) TRANSMISSION TUNNEL (HUMP) 


(57)ROOF RAIL 


FLOOR PAN 


(29) SIDE FOOTWELL PANEL (KICKPANEL) 


A-PILLAR 


DOOR PANEL 


(30) SILL 


B-PILLAR 


SECOND SEAT 




C-PILLAR 


FRONT SEAT 


EXTERNAL 


DOOR PANEL 


(64)ROOF RAIL 


(43) HOOD 


(58)ROOF 


ROOF OR CONVERTIBLE TOP 


(44) OBJECT EXTERNAL TO PASSENGER 


ROOF RAIL 


A-PILLAR 


COMPARTMENT BUT PART 


WINDOW FRAME 


B-PILLAR 


OF CASE VEHICLE 


DOOR PANEL 


WINDOW FRAME 


(45) OUTSIDE SURFACE OF CASE VEHICLE 




WINDOW HEADER 


(46) OTHER (E.G. SPARE TIRE, 


(59)BACKLIGHT HEADER 




JACK. DESCRIBE) 


ROOF 


(65)WINDSHIELD 


(49) UNKNOWN EXTERNAL OBJECT 


C-PILLAR 


WINDSHIELD HEADER 




THIRD SEAT-BACK 


ROOF SIDE RAIL 

(66)WINDSHIELD 

WINDSHIELD HEADER 
A-PILLAR 

(98)NOT APPLICABLE 
(99)UNKNOWN 



36 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module i. JL Format JL JL INTRUSION IT-5 
from the previous card. 9 10 11 12 


WAS THERE OCCUPANT COMPARTMENT INTRUSION? 0_ WAS INTRUSION CATASTROPHIC? 

13 14 
(H) WO QQflQJ ANSWER NE*T QUESTION SKP PAGE W NO COMPLETE PAGE. 
(1) YES ANSWER NEXT QUESTION. (1) YES &QEPAGE. 
(9) UNKNOWN SKIP PAGE 






Duplicate columns 1-8 Module J L. Format J2 2 

from the previous card. q 10 n 12 

NOTE: Each line in the table below is a separate record (card). Duplicate columns 1 - 12 tor each completed line. 


I NTRUSIONS CODE INTRUSIONS IN THIS ORDER: LEFT TO RIGHT ON ROW; FRONT TO BACK IN VEHICLES, 
CODES FOR B, F, G f H t I, J ON PAGE ITS 
nnnes rna C. nw page rr^ occupant CONTACT AND INJURY 


A B C D E F 6 

INTRUDING ASSOC. MAXIMUM MAXIMUM MAXIMUM 

INTRUSION OCC. COMPONENT EVENT INTRUSION INTRUSION INTRUSION 

NUMBER SPACE NO. OR OBJECT NO. X AXIS (cm) Y AXIS (cm) 2 AXIS (cm) 


' H 1 

OCCUPANT INJURY 
NUMBER NUMBER 


J K 

OCCUPANT INJURY 
NUMBER NUMBER 


13-14 15-16 17-18 19 20-21 22-23 24-25 


26-27 28-29 


30-31 32-33 


JJ_ J_ 






_Q_ _2_ 






3 






4 






5 






6 






7 






NOTE: USE ADDITIONAL PAGE IF MORE THAN 7 INTRUSIONS. 




• - 


Duplicate columns 1-8 Module I T Format _Q 2 

from the previous card. 9 10 11 12 


NOTE: IF NO SIDE DOOR INTRUSION, 
SKIP REMAINDER OF PAGE. 

SIDE DOOR INTRUSION 
RESULTED FROM 

INTRUSION 
NUMBER CAUSE 

CODES 
FOR CAUSE: 

"13 is" (1) DIRECT 
IMPACT 

16 18 (2) INDUCED 
DAMAGE 

19 21 (9) UNKNOWN 


IF DAMAGE TO DOOR COMPONENT RESULTEI 
DOOR INTRUSION, CODE COMPONENT 

INTRUSION DAMAGED DAMAGED 
NUMBER COMPONENT 1 COMPONENT 2 

J 

A _^ ( 

22 23 25 ( 

< 

B _ ( 

26 27 29 ( 

i 

c _ I 

30 31 33 


3 IN INCREASED 

CODES 
FOR COMPONENTS 

0) NONE 

1) A-PILLAR 

2) B-PILLAR 

3) C-PILLAR 

4) LATCH/STRIKER 

5) HINGES 

7) OTHER: 


D 

34 35 


1 
1 

37 


8) NOT APPLICABLE 

9) UNKNOWN 



37 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module J_ _J_ Format 2 INTRUSION IT-6 
from the previous card. q 10 n 12 

NOTE: Each line in the table below is a separate record (card). - ADDITIONAL PAGE - 
Duplicate columns 1 - 12 for each completed line. 


I NTRUSIONS CODE INTRUSIONS IN THIS ORDER: LEFT TO RIGHT ON ROW; FRONT TO BACK IN VEHICLES. 
CODES FOR B, F, G f H, I, J ONPAGErr-3 
CODES FOR C ON PAGE IT-4 OCCUPANT CONTACT AND INJURY 


A B C D E F G 

INTRUDING ASSOC. MAXIMUM MAXIMUM MAXIMUM 

INTRUSION OCC. COMPONENT EVENT INTRUSION INTRUSION INtRUSION 

NUMBER SPACE NO. OR OBJECT NO. X AXIS (cm) Y AXIS (cm) Z AXIS (cm) 


H 1 

OCCUPANT INJURY 
NUMBER NUMBER 


J K 

OCCUPANT INJURY 
NUMBER NUMBER 


13-14 15-16 17-18 19 20-21 22-23 24-25 


26-27 28-29 


30-31 32-33 


JLA 






9 _ 






J. -D- 






_L_L 






1 2 






J_JL 






14 . _ _ 






JLA 






-LA 






J. JL .„ 






11 






_L .2. 






-2. JL 






-2. _L . 






H 






-2.JL 






ii. 






-2-i 













38 



BEST AVAILABLE COPY 



Duplicate columns 1*8 


Module J Q_ Format.fi L_ 


Interior Damage ID-1 


from the previous card. 


9 10 11 12 








CODES: 












(0) NO 


(4) YES, and OCCUPANT CONTACT 






(1) YES 


(8) NOT APPLICABLE 






(3) NO, and OCCUPANT CONTACT (9) UNKNOWN 






I 
LEFT RIGHT 










Sides 






Front 


O 


Instrument Panel 


O 


FRONT DOOR 


O 


Q 


FOOT CONTROLS 


UPPER PANEL 




13 


14 




45 




55 

IP 


FRONT HARDWARE 


c 


Q 


IGNITION KEYS 


Q 


MID PANEL 




15 


16 




46 




S6 


FRONT ARMREST 


Q 





REAR VIEW MIRROR 





LOWER PANEL 


3 




17 


18 




47 




57 


FRONT GLASS 


Q> 





SUNVISOR/FTTTINGS 


g 


ASHTRAY 


C 




19 


20 




■ 48 




58 




O 


O 


(5) LEFT SIDE ONLY 








REAR DOOR AREA 


(6) RIGHT SIDE ONLY 




CONTROL KNOBS 


o 




21 


22 


(7) BOTH SIDES 




& LEVERS 


REAR HARDWARE 





Q 








59 




23 


24 


WINDSHIELD TOP 





GLOVE 


J 




Q 


O 


MOLDINGS 


COMPARTMENT AREA 


REAR ARMREST 




49 




60 




25 

Q 


26 

Q 


LEFTA-PILLAR 


a 


INSTRUMENTS 


o 


REAR GLASS 


(UPPER OR LOWER) 




61 




Z7 


28 




50 




P 




o 


Q 






PARKING BRAKE RELEASE 


ROOF SIDE RAIL 


RIGHT A-PILLAR 


g 




62 




29 


30 


(UPPER OR LOWER) 




o 




o 


o 




51 


PARKING BRAKE PEDAL 


B-PILLAR 









63 




31 


32 


CENTER CONSOLE 




q 

64 


C-PILLAR 





& 




52 


A/C OR UPPER VENT OUTLETS 




33 


34 


TRANSMISSION 


o 

53 




€> 

65 


D-PILLAR 


s- 


£- 


SELECTOR LEVER 


HEATER OR AC DUCTS 


HEADLINING 


35 

Q 


36 


RIM, HORN, SPOKE 


o 

54 


RADIO 


a 

66 


ROOF STRUCTURE 
T-ROOF/SUN ROOF 
OTHER: * 


37 

O 

39 

t 

41 
43 


38 

Q 

40 

t 

42 
44 






OTHER: * 


67 






Rear 

WINDOW 
WINDOW HEADER 


<3 

68 

69 
















Consoles 














VERTICAL 


3 

70 












ROOF 


71 



MOfff THAN ONE OEM MAY BE NOTED. 



39 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module _S IL Format JJ 2_ 


Seats 




ST-1 


from the previous card. b 10 


11 12 








Front Seat 


I ; 
Driver I Passen-r 




! 






i 


Front Seat-Back 


Driver 


I Passen-r 


TYPE OF FRONT SEAT 


i 
I 








(00) NO SEAT 

(01) STANDARD BENCH 


&£_\o£_ 


SEAT-BACK TYPE 


i 




(02) SPLIT BACK, 50-50 


13 14 


15 16 


(1) FORWARD FOLDING 


: 2 


: j, 


(03) SPLIT BACK, DRIVER WIDE 






(2) RIGID 


(04) SPLIT BACK, PASS. WIDE 






(3) RECLINING 


\ 30' 


I 31 


(05) BUCKET 

(06) CAPTAIN'S CHAIR 

(07) INDIV. BENCH, 50-50 






m OTHER: 




I 

i 


(8) NOT APPLICABLE 


(08) INDIV. BENCH, DRIVER WIDE 






(9) UNKNOWN 




; 


(09) INDIV. BENCH, PASS. WIDE 








i 


i 


(971 OTHER: 






SEAT-BACK LOCK TYPE 


I 


1 


(99) UNKNOWN 






(0) NONE 


_[ 


I 


TYPE OF SEAT MOUNT 






(1) MANUAL 


(1) STANDARD 


_L 


/ 


(2) INERTIA 


32 


33 


(2) PEDESTAL 




(3) POWER 






m OTHER: 


17 


16 


(7) OTHER: 






(8) NOT APPLICABLE 


(8) NOT APPLICABLE 


(9) UNKNOWN 






(9) UNKNOWN 






SWIVEL MECHANISM EQUIPPED 

(0) NO 

(1) YES 


19 


20 


LOCKS HELD 
(0) NO 


_( 


J 


(8) NOT APPLICABLE 






(1) YES 


34 


35 


(9) UNKNOWN 






(8) NOT APPLICABLE 

(9) UNKNOWN 






ORIGINAL EQUIPMENT SEATS 


J 

21 


22 








(0) NO 

(1) YES 


RECLINER MECHANISM 






(8) NOT APPLICABLE 






HELD 


J 


J 


(9) UNKNOWN 






(0) NO 


CONTACT OF SEAT 
BY REAR OCCUPANT 

(0) NO 





o 


(1) YES 

(8) NOT APPLICABLE 

(9) UNKNOWN 


36 


37 


(1) YES 


23 


24 








(8) NOT APPLICABLE 

(9) UNKNOWN 
























Head Restraint 






FRONT SEAT DAMAGE 






• • ^™» »•» ■ %^»%^ ■ • *#^ii v i 






(0) NONE 


O 


c 


HEAD RESTRAINT TYPE 






(1) BACKREST ONLY DAMAGED 


(0) NONE 


38 


J 


(2) CUSHION ONLY DAMAGED 

(3) BACKREST & 


25 


26 


(1) ADJUSTABLE 

(2) INTEGRAL 


39 


CUSHION DAMAGED 






(3) NOT INTEGRAL, BUT 






(8) NOT APPLICABLE 






CANNOT BE REMOVED 






(9) UNKNOWN 






(7) OTHER: 






(8) NOT APPLICABLE 


CENTER ARMREST DAMAGED 




(9) UNKNOWN 






(0) NO 

(1) YES 


& 


REMOVED PRE-CRASH 

(0) NO 


£> 


6 


(7) EQUIPPED, DAMAGE UNKNOWN 


27 


(1) YES 


40 


41 


(8) NOT APPLICABLE 




(8) NOT APPLICABLE 






(NO CENTER ARMREST) 




(9) UNKNOWN 






(9) UNKNOWN IF EQUIPPED 














ADJUSTMENT AT CRASH 

d) UP 


1 


2 




\ 


Front Seat Rotation 


\ 


(2) DOWN 

(8) NOT APPLICABLE 


42 


43 


(0) NONE APPARENT 


o 


o 


(9) UNKNOWN 






(1) FORWARD APPARENT 


26 


29 


HEAD RESTRAINT DAMAGE 






(2) REARWARD APPARENT 

(3) LEFT APPARENT 

(4) RIGHT APPARENT 






(0) NONE 

(1) DAMAGED BUT 
NOT SEPARATED 


o 

44 


g 

45 


(5) MULTIPLE ROTATIONS 






(2) SEPARATED 






SPECIFY 






(8) NOT APPLICABLE 






(8) NOT APPLICABLE 






(9) UNKNOWN 






(9) UNKNOWN 













40 



BEST AVAILABLE COPY 



Seats ST-2 


Front Seat Adjustment 


Driver 


Passewr 


Second Seat (cont.) 




SEAT ADJUSTMENT TYPE 






CENTER ARMREST DAMAGED 




(0) NONE (RIGID) 

(1) MANUAL 


i 


J 




8r 


(2) POWER 


46 


47 


(0) NO 


^^* 


m OTHER: 






(1) YES 

(7) EQUIPPED. 


60 


(8) NOT APPLICABLE fWOS£47) 


(9) UNKNOWN 






DAMAGE UNKNOWN 
(8) NOT APPLICABLE 




ADJUSTMENT PROVIDED 






(NO CENTER ARMREST) 




(1) 2-WAY 

(2) 4-WAY 

(3) 6-WAY 


J 

46 


J 

49 


(9) UNKNOWN IF EQUIPPED 




Second Seat-Back 


Left j Right 


m OTHER: 








i 


(8) NOT APPLICABLE 












(9) UNKNOWN 






Locks 






SEAT ADJUSTER DAMAGE 












(0) NONE 


Q 


o 


FOR THE FOLLOWING, USE: 






(1) CHUCKING (FREE PLAY) 








(2) DEFORMED (RELEASED/JAMMED) 


50 


51 


(0) NO 


i 


(3) SEPARATED 






(1) YES 






C7\ OTHER: 






(8) NOT APPLICABLE 

(9) UNKNOWN 


i 




(8) NOT APPLICABLE 


(9) UNKNOWN 








o 








LEFT OR CENTER, EQUIPPED 


SEAT ADJUSTER SEPARATION 








61 


62 


(0) NONE 

(1) SEPARATED AT FLOOR 


X 


r 


LEFT OR CENTER, HELD 


_/ 


Sr 


(2) SEPARATION OF ADJUSTER 


52 


53 




63 


64 


(3) SEPARATED AT SEAT 






(3) SEAT FOLDED DOWN 




/ 


(8) NOT APPLICABLE 








o 


(9) UNKNOWN 






RIGHT, EQUIPPED 







PRE-CRASH POSITION 


L 






65 


66 

I 




2 


RIGHT, HELD 


(1) FORWARD 




67 


66 


(2) MIDDLE 


54 


55 


(3) SEAT FOLDED DOWN 






(3) REARWARD 

(8) NOT APPLICABLE 


















(9) UNKNOWN 






Third Seat 
equipped 


Q 


o 


Second Seat 


LEFT 


Right 


TYPE OF SECOND SEAT 








69 

Sr 


\ 








BACKREST DAMAGED 


(0) NONE 








71 


72 


(1) NON-FOLDING 

(2) FOLDING 


I 


i 


CUSHION DAMAGED 


2- 


?r 


(3) CAPTAIN'S CHAIR 




73 


74 


(4) JUMP SEAT 

(5) INTEGRAL CHILD SEAT 


56 


57 












(6) LUGGAGE AREA ACCESS PANEL 










(9) UNKNOWN 






Vehicle Equipped with 
Rear Head Restraints 




SECOND SEAT DAMAGE 










(0) NONE 










(1) BACKREST ONLY 






(0) NOT EQUIPPED 




(DAMAGED OR LOOSENED) 






(OR REMOVED) 


a 


(2) CUSHION ONLY 





Q 


(1) EQUIPPED 


(DAMAGED OR LOOSENED) 


(2) EQUIPPED & DAMAGED 


%^ 


(3) BACKREST & CUSHION 


56 


59 


(8) NOT APPLICABLE 


75 


(DAMAGED OR LOOSENED) 






(NO REAR SEAT) 




(4) INTEGRAL CHILD SEAT 






(9) UNKNOWN 




(PRIORITY CODE) 










(5) LUGGAGE AREA ACCESS PANEL 






Applies to any rear-seat position 




(DAMAGED OR LOOSENED) 










(8) NOT APPLICABLE 










(9) UNKNOWN 











41 



BEST AVAILABLE COPY 



Duplicate columns 1-8 Module A. B Format _Q i_ 

from the previous card. 9 10 11 12 


Airbag 


AB-1 


DRIVER SIDE 


t 

i 

I 


PASSENGER SIDE 


i 


Location of Airbag 


I 


Location of Airbag 


! 


Steering Wheel 




Instrument Panel (glove box) 




EQUIPPED 


_/ 

13 


EQUIPPED 


1 

i 

1 


(0) NO 

(1) YES 

(4) PRIOR DEPLOYMENT 

NOT REINSTALLED 
(9) UNKNOWN IF AIRBAG EQUIPPED 


(0) NO 

(1) YES 

(4) PRIOR DEPLOYMENT 

NOT REINSTALLED 
(9) UNKNOWN IF AIRBAG EQUIPPED 


! / 

i ~T 

1 

1 
1 

1 


DEPLOYED 


_/ 

14 


DEPLOYED 




(0) NO 

(1) YES 

(2) PARTIAUIMPROPER DEPLOYMENT 

(8) NOT APPLICABLE 

(NO AIRBAG) 

(9) UNKNOWN 


(0) NO 

(1) YES 

(2) PARTIAL/IMPROPER DEPLOYMENT 

(8) NOT APPLICABLE 

(NO AIRBAG) 

(9) UNKNOWN 




17 


Condition of Airbag 




Condition of Airbag 




Steering Wheel 




Instrument Panel (glove box) 




(0) NO DAMAGE 

(2) SPLIT OR TORN 

(3) CUT DURING CRASH 

(4) BURNED/MELTED 

(5) CUT POST CRASH 

(6) OTHER 

(7) DAMAGED, CONDITION UNKNOWN 

(8) NOT APPLICABLE inoteouippebnot deployed) 

(9) UNKNOWN IF EQUIPPED 

OR CONDITION 


O 

15 


(0) NO DAMAGE 

(2) SPLIT OR TORN 

(3) CUT DURING CRASH 

(4) BURNED/MELTED 

(5) CUT POST CRASH 

(6) OTHER 


8- 

18 


(7) DAMAGED, CONDITION UNKNOWN 

(8) NOT APPLICABLE wbxmppeunot deployed) 

(9) UNKNOWN IF EQUIPPED 

OR CONDITION 


DRIVER SIDE 




PASSENGER SIDE 




Airbag 




Airbag 




Steering Wheel 




Instrument Panel (glove box) 




TETHER 




TETHER 




(0) NO 

(1) YES 

(6) OTHER 

(7) UNKNOWN IF TETHERED j 

(8) NOT APPLICABLE 

(NO AIRBAG) 

(9) UNKNOWN IF AIRBAG EQUIPPED 


_/ 

19 


(0) NO 

(1) YES 
(6) OTHER 


21 


(7) UNKNOWN IF TETHERED 

(8) NOT APPLICABLE 

(NO AIRBAG) 

(9) UNKNOWN IF AIRBAG EQUIPPED 


MARKED BY CONTACT 




MARKED BY CONTACT 




(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(NO AIRBAG) 

(9) UNKNOWN 


20 


(0) NO 

(1) YES 

(8) NOT APPLICABLE 

(NO AIRBAG) 

(9) UNKNOWN 


1 

22 



42 



BEST AVAILABLE COPY 



AlRBAG AB-2 



Airbag Number on driver side: 



NOTE AND DESCRIBE ANY AIRBAG CONTACT OR 
DAMAGE ON DIAGRAM BELOW: 




IS- S7* 



Airbag Number on passenger side: 



NOTE AND DESCRIBE ANY AIRBAG CONTACT OR 
DAMAGE ON DIAGRAM BELOW: 




43 



BEST AVAILABLE COPY 



NOTE TO THF INvrsTinAjnp- 

THE FOLLOWING TWO SECTIONS, 

OCCUPANT INFORMATION AND INJURY CLASSIFICATION, 

ARE TO BE FILLED IN 

FOR EACH CASE VEHICLE OCCUPANT, 

WHETHER INJURED OR NOT. 

IF THERE IS MORE THAN ONE OCCUPANT, 

USE ADDITIONAL COPIES 

OF PAGES OC-1 , OC-2, OC-3, 

AND IC-2 TO DESCRIBE THEM 

AND ATTACH THE COPIES TO THIS REPORT 



44 



BEST AVAILABLE COPY 



TEAM REPORT NUMBER: J^ M — <1- 2- jf -L I_ 9 & 



Duplicate columns 1-8 Module _Q. _£_ Format JL _2_ OCCUPANT INFORMATION OC-1 


from the previous card. 9 10 11 12 




Occupant Identification 


Ql 


Physical Description 




OCCUPANT NUMBER 


AGE IN years 


is: 




13 14 


(00) LESS THAN 1 YEAR 






(98) 98 YEARS OR OLDER 


20 21 


ROLE OF OCCUPANT AT 1ST IMPACT 


1 


(99) UNKNOWN 




(1) MOTOR VEHICLE DRIVER 


AGE IN MONTHS 


357 


(2) MOTOR VEHICLE PASSENGER 


15 


(00) LESS THAN 1 MONTH 


(NOT DRIVER) 




(25) 25 MONTHS OR OLDER 


22 23 


(9) UNKNOWN ! 


(99) UNKNOWN 
MASS (kg) 








Occupant Position 




(999) UNKNOWN I I ^ k fi«S 


24 25 26 


ROW LOCATION 


_/ 


HEIGHT (cm) C*?*' 
(999) UNKNOWN ^ 


Jfco 


(1) FRONT 


(2) SECOND 


16 




27 28 29 


(3) THIRD 








(4) FOURTH 




SEX 


3 

30 


m OTHER: 




(1) MALE 

(2) FEMALE 


(8) EXTERNAL TO PASSENGER 


COMPARTMENT (EG. BED OF PICKUP) 




(9) UNKNOWN 




(9) UNKNOWN 








Medical Conditions 




LATERAL LOCATION 


# 






(D LEFT 


_/ 


TREATMENT/MORTALITY 
(00) NONE 


QO 


(2) LEFT CENTER 


17 


(01) FIRST AID AT SCENE 


31 32 


(3) CENTER 




(02) TREATED AT HOSPITALyCLINIC 




(4) RIGHT CENTER 




BUT NOT ADMITTED 




(5) RIGHT 




(03) HOSPITALIZED FOR OBSERVATION 




(6) ALL (LYING ON SEAT) 




LESS THAN 24 HOURS 




(8) EXTERNAL TO PASSENGER 




(04) HOSPITALIZED OVER 24 HOURS 




COMPARTMENT 




OR FOR SIGNIFICANT TREATMENT 




(9) UNKNOWN 




(05) FATAL, DEAD AT SCENE 

(06) FATAL, DOA 

(07) FATAL, DEAD WITHIN 24 HOURS 




POSTURE 




(08) FATAL, DEAD 24 HOURS TO 






±<L 


31 DAYS LATER 




(10) SITTING ON SEAT 


(09) FATAL, DEAD 31 DAYS TO 




(11) SITTING ON SEAT IN ABNORMAL 


18 19 


1 YEAR LATER 




POSITION (E.G. FEET ON DASH, 




(10) FATAL DEAD WITHIN UNKNOWN 




SIDEWAYS) 




PERIOD 




(12) SITTING ON CONSOLE 




(99) UNKNOWN 




(20) ON LAP OR IN ARMS 








(30) STANDING ON SEAT 




INJURY SEVERITY SCORE (ISS) 




(40) STANDING ON FLOOR 






_£1 


(47) STANDING. EXTERNAL TO 




(99) UNKNOWN 


PASSENGER COMPARTMENT 






33 34 


(50) IN BASSINET 








(60) IN CHILD SEAT 




NON-IMPACT MED. CONDITIONS 


6 


(65) IN CHILD HARNESS 




(0) NONE 


(70) LYING ON SEAT 




(1 ) YES, TIME & TYPE UNKNOWN 


(80) LYING/SITTING ON PASSENGER 




(2) PRE-CRASH FATAL (CUNICAL 


35 


FLOOR 




DEATH AT WHEEL) 




(83) LYING/SITTING ON OTHER 




(3) PRE-CRASH NON-FATAL (EG. 




OBJECT IN PASSENGER 




PRIOR INJURY, STROKE) 




COMPARTMENT: 




(4) PREGNANT 




(85) ON CARGO FLOOR/FOLDED 




(5) POST-CRASH FATAL (DROWNING) 




SEAT-BACK 




(6) POST-CRASH NON-FATAL INJURY 




(87) LYING/SITTING, EXTERNAL TO 




m OTHER: 




PASSENGER COMPARTMENT 




(8) COMBINATION OF ABOVE 




(97) OTHER: 




(CIRCLE EACH) 
(9) UNKNOWN 




(99) UNKNOWN 



45 



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Medical Conditions (cont.) 



POLICE INJURY SEVERITY 
CODE FOR THIS OCCUPANT 



O - NO INJURY 

C • POSSIBLE INJURY 

B - NON-INCAPACITATING 

(3) A - INCAPACITATING INJURY 

(4) K- FATAL 
INJURED. SEVERITY UNKNOWN 
DIED PRIOR TO IMPACT 

(7) NON-FATAL INJURY. 

SEVERITY UNKNOWN 
(9) UNKNOWN 



(0) 
d) 
(2) 



(5) 
(6) 



O 



36 



Restraint System 



ACTIVE RESTRAINT SYSTEM 

(0) NONE 

(1) LAP BELT 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(9) UNKNOWN 



ACTIVE RESTRAINT SYSTEM USAGE 

(0) NONE (AVAILABLE BUT NOT USED) 

(1) LAP BELT ONLY 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(7) IMPROPER USAGE 

(8) HOT APPLICABLE (NONE AVAILABLE) 

(9) UNKNOWN 



PASSIVE RESTRAINT SYSTEM 

(0) NONE 

(1) AIRBAG INSTALLED 

(2) PASSIVE UPPER TORSO 
WITH KNEE BOLSTERS 

(3) PASSIVE UPPER TORSO 
WITHOUT KNEE BOLSTERS 

(4) PASSIVE LAP & UPPER TORSO 

(5) AIRBAG INSTALLED & 

PASSIVE RESTRAINT 

(7) OTHER: 

(9) UNKNOWN 



Occupant Information OC-2 



CHILD SEAT TYPE 

(00) NONE USED 

(01) YES, USED 

(02) INTEGRAL, Chrysler Mini-van 
(88) NOT APPLICABLE 

(ADULT OR OLDER CHILD) 
(99) UNKNOWN 

CHILD SEAT MAKE/MODEL 



! 41 42 



37 



36 



i 



PASSIVE RESTRAINT SYSTEM USAGE 

(0) SYSTEM DEFEATED 

(1) AIRBAG NOT DEPLOYED 

(2) AIRBAG DEPLOYED 

(3) AIRBAG NOT REINSTALLED 

(4) PASSIVE UPPER TORSO USED 

(5) PASSIVE LAP & UPPER TORSO USED 

(6) SYSTEM USED IN MANUAL MODE 

(7) IMPROPER USAGE 

(8) NOTAPPUCABLEr/VOrOff/G/A/ALLY 
EQUIPPED) 

(9) UNKNOWN 



Ejection 

DEGREE OF EJECTION 

(0) NONE 

(1) PARTIAL 

(2) COMPLETE 

(7) EJECTED, DEGREE UNKNOWN 
(9) UNKNOWN IF EJECTED 

AREA OF EJECTION 

(01) WINDOW, LEFT SIDE 

(02) WINDOW, RIGHT SIDE 

(03) WINDOW, REAR 

(04) DOOR, LEFT SIDE 

(05) DOOR, RIGHT SIDE 

(06) DOOR, REAR OR TAILGATE 

(07) WINDSHIELD 

(08) ROOF OR OPEN CONVERTIBLE OR 
FROM EXTERNAL AREA 

(96) EJECTED AREA UNKNOWN 

(97) OTHER AREA: 

(98) NOT APPLICABLE 0VOT EJECTED) 

(99) UNKNOWN IF EJECTED 



o 



SI 

44 49 



IF OCCUPANT WAS EJECTED, DESCRIBE 
IN DETAIL BELOW: 



Head Restraint 

head restraint available 
for this position 

(0) NOT EQUIPPED OR REMOVED 

(1) EQUIPPED 
(9) UNKNOWN 



J 



46 



BEST AVAILABLE COPY 



Occupant Information OC-3 



OCCUPANT EYEWEAR 

(0) NONE 

(1) GLASSES 

(2) CONTACTS 

(3) BOTH GLASSES AND CONTACTS 



(4) OTHER 

(8) NOT APPLICABLE 

(9) UNKNOWN 



47 



QY- 



SOURCE OF INFORMATION 

('(OHNTERVIEW 
(T) HOSPITAL 



(2) 
(3) 
(4) 
(5) 
(7) 
(8) 
O) 



AUTOPSY 
POLICE 
OTHER 



<3 



48 



LAY CORONER/EXTERNAL EXAM 
COMBINATION OF ABOVE (CIRCLE) 
NOT APPLICABLE 
UNKNOWN 



47 



BEST AVAILABLE COPY 



Abrasion, right 

anterior upper arm 

(1) 



Abrasion, right anterior 

wrist, forearm, and 

elbow 

(D 



Abrasion, top 

of right thumb 

(1) 



Occupant Information OC-4 



INDICATE LOCATION OF INJURIES. 




Contusion, left shoulder 
(1) 



Abrasion, top 

of left thumb 

(D 




Cervical strain 
(D 



48 



BEST AVAILABLE COPY 



Duplicate columns 1-8 
from the previous card. 



Module J £_ Format JJ L 

9 10 11 12 



Injury Classification IC-1 



NOTE: Each line in the table below is a separate record (card). 
Duplicate columns 1 - 12 tor each completed line. 



Occupant Injury Classification 



PRIMARY OIC 



ASSOCIATED OIC 



COMMENTS 



o 

c 

1 



c 

m 

m 
30 



c 

X 

< 
z 
c 
s 

w 
m 

3D 



PLACE CONTACTS IN ORDER OF 
PROBABILITY (HORIZONTALLY) . 
START Viim MOST PROBABLE 
IN 1ST CONTACT AREA COLUMN. 

AREA(S) OF POSSIBLE CONTACT 
1ST 2ND 



S 



8 



i 

i 



8 

s 



CO 

i 

3 



9 

3 i 



13-14 



15-16 



17-18 



19-20 



COMMENTS 



2^ 



23 24 252627282930 



0/ 



E 

3 

z 



01 

OS 

az 



VL 

it 

VL 
*7 



?7 



17 
z2 
VL 



S L C XT / 



/? * // jr / 



* £ A £'_ 



W A * I L 
W £ £ T 1 

W L ri r f 



NOTE: USE ADDITIONAL PAGES IF NECESSARY. 



49 



BEST AVAILABLE COPY 



Injury Classification IC-2 



CODES FOR AREAS OF POSSIBLE OCCUPANT CONTACT 



Front of Passenger Compartment 

(10) sunvisor, fitting^ 4/or top molding 

(12) windshield 

(05) instrument panel (specific area unknown) 

(54) upper instrument panel (x) 

(55) middle instrument panel (y) 

(56) lower instrument panel (z) 
(81) ash tray (instrument panel) 

(02) glove compartment area 

(47) airbag (acrs) compartment door/cover 

(57) beneath instrument panel 
(s3) parcel tray 

(48) knee restraint 
(86) vertical console 

(28) foot controls (incl parking brake pedal) 

(09) steering assembly (specific area unknown) 

(65) steering wheel 

(66) steering wheel column 

(59) transmission lever on column 

(03) hardware item (specific area unknown) 

(82) INSTRUMENT^ 

(83) CONTROL KNOBfS; & LEVERS (FRONT) 

(84) PARKING BRAKE HANDLE IN FRONT 

(67) IGNmON KEY 
(06) MIRROR 

(04) - HEATER OR AIR CONDITIONING DUCTS 

(01) AIR CONDITIONING OR VENTILATION OUTLETS 

(08) RADIO (BUILT IN) 

(58) addon tape deck, radio. a/c 

(68) roof mounted controls/consoles 

Rear 

(88) surface of rear interior 

(23) rear window 

(39) rear window header 

(50) rear seat cushion & back 

Interior-General 

(11) transmission selection lever (location unk) 

(59) transmission lever on steering column 
(44) transmission lever on floor or console 
(07) parking brake handle (location unknown) 

(84) parking brake handle in front 

(85) parking brake handle on floor or console 
(28) foot controls (incl parking brake pedal) 



(29) 


FRONT SEAT-BACKfS; 


(51) 


FRONT SEAT CUSHION 


(50) 


REAR SEAT CUSHION & BACK 


(49) 


ARMREST ON SEAT 


(89) 


UNDER SEAT BOTTOM 


(33) 


RESTRAINT SYSTEM HARDWARE 


(34) 


RESTRAINT SYSTEM WEBBING 


(87) 


AIR CUSHION SKIN (AIRBAG) 


(47) 


AIRBAG (ACRS) COMPARTMENT DOOR/COVER 


(46) 


AIRBAG GAS 


(48) 


KNEE RESTRAINT 


(30) 


HEAD RESTRAINT 


(42) 


CHILD SEAT RESTRAINTS 


(43) 


CHILD SEAT 


(31) 


INTERIOR LOOSE OBJECT 


(32) 


OTHER OCCUPANTS 


(52) 


INTERNAL FLYING GLASS (FROM ANY SOURCE) 


(41) 


UNKNOWN INTERIOR SURFACE 



Sides 

(20) surface of side interior 

(19) hardware on side or door 
(13) armrest on side or door 
(24) coat hook 

(22) window glass (side) 

(21 ) window frames (side) 

(26) roof side rail 



A-PILLAR 
B-PILLAR 

(16) C-PILLAR 

(17) D-PILLAR 



(14) 
(15) 



Floor 

(40) FLOOR 

(27) console on floor or between seats 

(44) transmission lever on floor or console 

(85) parking brake handle on floor or console 

(28) foot controls (incl parking brake pedal) 
(91) kickpanel 

Roof 

(25) roof or convertible top 

(10) sunvisor, fitting^ 4/or top molding 

(26) roof side rail 
(24) coat hook 
(18) dome light 

(39) backlight header 

(68) roof mounted controls/console 

(69) ROLL BAR 

Exterior Surface of Case Vehicle 

(37) outside surface of case vehicle 
(specific area unknown) 

(35) hood of case vehicle 

(60) exterior of case vehicle /eg. 
outside mirrors, antenna, trim) 

(62) exterior side roof rail of case vehicle 

(63) trunk ud of case vehicle 

(64) tires of case vehicle 

Beyond Case Vehicle Boundary 

(36) area exterior to car (specific area unk) 

(70) hood of other vehicle 

(71) other vehicle exterior hardware (eg. 
outside mirrors, antenna, trim) 

(73) exterior side roof rail of other vehicle 

(74) headlight or front grill of other veh. 

(75) trunk of other vehicle 

(76) outside surface of other vbkcle 

(77) tires of other vehicle 

(78) GROUND 

(79) WATER 

(80) exterior object (not vehicle, ground, 
or water. please describe) 

Penetrating Objects 

(61) other vehicle 

(72) objects (describe) 

Miscellaneous 

(00) no contact (invalid field form code) 

(38) other (eg. fire describe) 
(90) spare tire 

(96) INDUCED 

(97) EJECTED. UNKNOWN CONTACT 

(98) IMPACT FORCE. -WHIPLASH*, 
HYPEREXTENSION/COMPRESSION 

(99) UNKNOWN AREA OF CONTACT 



50 



BEST AVAILABLE COPY 



Injury Classification IC-3 



THE FIGURE BELOW 

IS AN EXPLANATION OF THE BODY REGION CODES 

LISTED ON PAGE IC- 4. 




51 



BEST AVAILABLE COPY 



Injury Classification IC-4 



1 



CODES FOR OCCUPANT INJURY CLASSIFICATION (OIC) 



BODY REGION 

(H) HEAD/SKULL 

(F) FACE 

(N) NECK 

(S) SHOULDER 

(X) UPPER EXTREMITIES 

(A) ARM (UPPER) 
(E) ELBOW 

(R) FOREARM 
(W) WRIST/HAND 
(C) CHEST 
(M) ABDOMEN 

(B) BACK 

(P) PELVIC/HIP 

(Y) LOWER EXTREMITIES 

(T) THIGH 

(K) KNEE 

(L) LEG (LOWER) 

(Q) ANKLE/FOOT 

(O) WHOLE BODY 

(U) UNKNOWN 



ASPECT 
(R) RIGHT 
(L) LEFT 

(B) BILATERAL 

(C) CENTRAL 

(A) ANTERIOR/FRONT 
(P) POSTERIOR/BACK 
(S) SUPERIOR/UPPER 
(I) INFERIOR/LOWER 
(W) WHOLE REGION 
(U) UNKNOWN 



LESION 

(L) LACERATION 

(C) CONTUSION 

(A) ABRASION 

(F) FRACTURE 

(P) PERFORATION, 
PUNCTURE 

(K) CONCUSSION 

(V) AVULSION 

(R) RUPTURE 

(S) SPRAIN 

(D) DISLOCATION 
(N) CRUSH 

(M) AMPUTATION 

(B) BURN 

(G) DETACHMENT, 
SEPARATION 

(Z) FRACTURE AND 
DISLOCATION 

(T) STRAIN 

(E) TOTAL SEVERANCE, 
TRANSECTION 

(O) OTHER 

(U) UNKNOWN 









CO 




CD 






-c 




o 






CO 




n 






H 




-< 






m 




X 

m 


> 

CO 


1— 

m 


2 

6 


CO 

5 


C) 


"D 


CO 


3 


m 


O 

z 


m 
o 


5 

z 


> 

z 


73 

1 



12 3 4 5 



SYSTEM/ORGAN 
(S) SKELETAL 
(V) VERTEBRAE 
(J) JOINTS 

(D) DIGESTIVE 
(L) LIVER 

(N) NERVOUS SYSTEM 

(B) BRAIN 

(C) SPINAL CORD 

(E) EARS 

(0) EYES 

(A) ARTERIES 

(H) HEART 

(Q) SPLEEN 

(G) UROGENITAL 

(K) KIDNEYS 

(R) RESPIRATORY 

(P) PULMONARY/LUNGS 

(M) MUSCLES 

(T) THYROID, OTHER 

ENDOCRINE GLAND 

(1) INTEGUMENTARY (SKIN) 
(W) ALL SYSTEMS IN REGION 
(U) UNKNOWN 



SEVERITY 

(OR 'AIS'. ABBREVIATED 
INJURY SCALE) 

(0) NONE 

(1) MINOR 

(2) MODERATE 

(3) SERIOUS 

(4) SEVERE 

(5) CRITICAL 

(6) MAXIMUM 
(9) UNKNOWN 



52 



BEST AVAILABLE COPY 



TEAM REPORT NUMBER: 



o/k - 3 7 ¥ / - 9 % 



Duplicate columns 1-8 Module _Q. JL_ Format JL -i. OCCUPANT INFORMATION OC-1 


from the previous card. 9 10 11 12 




Occupant Identification 




Physical Description 


i 

i 


OCCUPANT NUMBER 


£2 


AGE IN YEARS 


1SL 




13 14 


(00) LESS THAN 1 YEAR 


ROLE OF OCCUPANT AT 1ST IMPACT 


£ 


(98) 98 YEARS OR OLDER 

(99) UNKNOWN 


20 21 

1 


(1) MOTOR VEHICLE DRIVER 


AGE IN MONTHS 


i^s: 


(2) MOTOR VEHICLE PASSENGER 


15 


(00) LESS THAN 1 MONTH 


(NOT DRIVER) 




(25) 25 MONTHS OR OLDER 


22 23 


(9) UNKNOWN 




(99) UNKNOWN 

masses; ^ 

(999) UNKNOWN f 


1 
f 


i 


Occupant Position 




24 25 26 


ROW LOCATION 




HEIGHT rem; £'/ 
(999) UNKNOWN 




(1) FRONT 


1 


/££ 


(2) SECOND 


16 




27 28 29 


(3) THIRD 








(4) FOURTH 




SEX 


J_ 

30 


(7) OTHER: 




(1) MALE 

(2) FEMALE 


(8) EXTERNAL TO PASSENGER 


COMPARTMENT (EG. BED OF PICKUP) 




(9) UNKNOWN 




(9) UNKNOWN 








Medical Conditions 




LATERAL LOCATION 










£ 


TREATMENT/MORTALITY 


&o_ 


(1) LEFT 


(00) NONE 


(2) LEFT CENTER 


17 


(01) FIRST AID AT SCENE 


31 32 


(3) CENTER 




(02) TREATED AT HOSPITAL/CLINIC 




(4) RIGHT CENTER 




BUT NOT ADMITTED 




(5) RIGHT 




(03) HOSPITALIZED FOR OBSERVATION 




(6) ALL (LYING ON SEAT) 




LESS THAN 24 HOURS 




(8) EXTERNAL TO PASSENGER 




(04) HOSPITALIZED OVER 24 HOURS 




COMPARTMENT 




OR FOR SIGNIFICANT TREATMENT 




. (9) UNKNOWN 




(05) FATAL, DEAD AT SCENE 

(06) FATAL, DOA 




POSTURE 




(07) FATAL, DEAD WITHIN 24 HOURS 






(08) FATAL, DEAD 24 HOURS TO 






IP— 


31 DAYS LATER 




(10) SITTING ON SEAT 


(09) FATAL. DEAD 31 DAYS TO 




(1 1 ) SITTING ON SEAT IN ABNORMAL 


18 19 


1 YEAR LATER 




POSITION (EG. FEET ON DASH, 




(10) FATAL DEAD WITHIN UNKNOWN 




SIDEWAYS) 




PERIOD 




(12) SITTING ON CONSOLE 




(99) UNKNOWN 




(20) ON LAP OR IN ARMS 








(30) STANDING ON SEAT 




INJURY SEVERITY SCORE (ISS) 




(40) STANDING ON FLOOR 






OO 


(47) STANDING, EXTERNAL TO 




(99) UNKNOWN 


PASSENGER COMPARTMENT 






33 34 


(50) IN BASSINET 








(60) IN CHILD SEAT 




NON-IMPACT MED. CONDITIONS 




(65) IN CHILD HARNESS 




(0) NONE 


O 


(70) LYING ON SEAT 




(1) YES, TIME & TYPE UNKNOWN 


(80) LYING/SITTING ON PASSENGER 




(2) PRE-CRASH FATAL (CLINICAL 


35 


FLOOR 




DEATH AT WHEEL) 




(83) LYING/SITTING ON OTHER 




(3) PRE-CRASH NON-FATAL (E.G. 




OBJECT IN PASSENGER 




PRIOR INJURY, STROKE) 




COMPARTMENT: 




(4) PREGNANT 




(85) ON CARGO FLOOR/FOLDED 




(5) POST-CRASH FATAL (DROWNING) 




SEAT-BACK 




(6) POST-CRASH NON-FATAL INJURY 




(87) LYING/SITTING. EXTERNAL TO 




(7) OTHER: 




PASSENGER COMPARTMENT 




(8) COMBINATION OF ABOVE 




<97> OTHER: 




(CIRCLE EACH) 
(9) UNKNOWN 




(99) UNKNOWN 

i 



53 



BEST AVAILABLE COPY 



Occupant Information OC-2 



Medical Conditions (COnt.) 



POLICE INJURY SEVERITY 
CODE FOR THIS OCCUPANT 

(0) O - NO INJURY 

(1) C - POSSIBLE INJURY 

(2) B • NON-INCAPACITATING 

(3) A - INCAPACITATING INJURY 

(4) K- FATAL 

(5) INJURED. SEVERITY UNKNOWN 

(6) DIED PRIOR TO IMPACT 

(7) NON-FATAL INJURY, 

SEVERITY UNKNOWN 
(9) UNKNOWN 



Restraint System 



ACTIVE RESTRAINT SYSTEM 

(0) NONE 

(1) LAP BELT 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(9) UNKNOWN 



ACTIVE RESTRAINT SYSTEM USAGE 

(0) NONE (AVAILABLE BUT NOT USED) 

(1) LAP BELT ONLY 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(7) IMPROPER USAGE 

(8) NOT APPLICABLE (NONE AVAILABLE) 

(9) UNKNOWN 



PASSIVE RESTRAINT SYSTEM 

(0) NONE 

(1) AIRBAG INSTALLED 

(2) PASSIVE UPPER TORSO 
WITH KNEE BOLSTERS 

(3) PASSIVE UPPER TORSO 
WITHOUT KNEE BOLSTERS 

(4) PASSIVE LAP & UPPER TORSO 

(5) AIRBAG INSTALLED & 
PASSIVE RESTRAINT 

(7) OTHER: __ 

(9) UNKNOWN 



6 



CHILD SEAT TYPE 

(00) NONE USED 

(01) YES, USED 

(02) INTEGRAL, Chrysler Mini-van 
(88) NOT APPLICABLE 

(ADULT OR OLDER CHILD) 
(99) UNKNOWN 

CHILD SEAT MAKE/MODEL 



1L 



37 



/ 



Ejection 
degree of ejection 

(0) NONE 

(1) PARTIAL 

(2) COMPLETE 

(7) EJECTED, DEGREE UNKNOWN 
(9) UNKNOWN IF EJECTED 

AREA OF EJECTION 

(01) WINDOW, LEFT SIDE 

(02) WINDOW, RIGHT SIDE 

(03) WINDOW, REAR 

(04) DOOR, LEFT SIDE 

(05) DOOR, RIGHT SIDE 

(06) DOOR, REAR OR TAILGATE 

(07) WINDSHIELD 

(08) ROOF OR OPEN CONVERTIBLE OR 
FROM EXTERNAL AREA 

(96) EJECTED AREA UNKNOWN 

(97) OTHER AREA: 

(98) NOT APPLICABLE (NOT EJECTED) 

(99) UNKNOWN IF EJECTED 



O 

43 



92- 



44 45 



If: OCCUPANT WAS EJECTED, DESCRIBE 
IN DETAIL BELOW: 



PASSIVE RESTRAINT SYSTEM USAGE 

(0) SYSTEM DEFEATED 

(1) AIRBAG NOT DEPLOYED 

(2) AIRBAG DEPLOYED 

(3) AIRBAG NOT REINSTALLED 

(4) PASSIVE UPPER TORSO USED 

(5) PASSIVE LAP & UPPER TORSO USED 

(6) SYSTEM USED IN MANUAL MODE 

(7) IMPROPER USAGE 

(8) NOT APPLICABLE (NOT ORIGINALLY 
EQUIPPED) 

(9) UNKNOWN 



/ 



40 



Head Restraint 

head restraint available 
for this position 

(0) NOT EQUIPPED OR REMOVED 

(1) EQUIPPED 
(9) UNKNOWN 



i 



SY 



Occupant Information OC-3 



OCCUPANT EYEWEAR 

(0) NONE 

(1) GLASSES 

(2) CONTACTS 

(3) BOTH GLASSES AND CONTACTS 

(4) OTHER 

(8) NOT APPLICABLE 

(9) UNKNOWN 



47 



SOURCE OF INFORMATION 

^O^ITERVIEW 

(1) HOSPITAL 

(2) AUTOPSY 

(3) POLICE 

(4) OTHER 

(5) LAY CORONER/EXTERNAL EXAM 

(7) COMBINATION OF ABOVE (CIRCLE) 

(8) NOT APPLICABLE 

(9) UNKNOWN 



48 



BEST AVAILABLE COPY 



«fr 



Occupant Information OC-4 



INDICATE LOCATION OF INJURIES. 




No Injury 




56 



Duplicate columns 1 -8 
from the previous card. 



Module J_ 
o 



C Format Q 

10 11 



Injury Classification IC-1 



NOTE: Each line in the table below is a separate record (card). 
Duplicate columns 1 - 12 for each completed line. 



Occupant Injury Classification 



PRIMARY OIC 



§ 



z 
c 
z 

CD 

m 



Z 

c 
C 



z 
c 
z 

CD 

m 



PLACE CONTACTS IN ORDER OF 
PROBABILITY (HORIZONTALLY) . 
START WITH MOST PROBABLE 
IN 1ST CONTACT AREA COLUMN. 

AREA(S) OF POSSIBLE CONTACT 
1ST 2ND 



3 

3 






3 
2 



ASSOCIATED OlC 



1 



I c 



COMMENTS 



13-14 



15-16 



17-18 



19-20 



COMMENTS 



21 22 23 24 25 



26 27 28 29 30 



£2 



/U£> /^^-o»^/<s^r 



M07E: USE ADDITIONAL PAGES IF NECESSARY. 



sy 



BEST AVAILABLE COPY 



Injury Classification 1C-2 



CODES FOR AREAS OF POSSIBLE OCCUPANT CONTACT 



Front of Passenger Compartment 

(10) SUNVISOR. FITTINGS &/OR TOP MOLDING 

(12) WINDSHIELD 

(05) INSTRUMENT PANEL (SPECIFIC AREA UNKNOWN) 

(54) UPPER INSTRUMENT PANEL (X) 

(55) MIDDLE INSTRUMENT PANEL (Y) 

(56) LOWER INSTRUMENT PANEL (Z) 
(61) ASH TRAY (INSTRUMENT PANEL) 
(02) GLOVE COMPARTMENT AREA 

(47) AJRBAG (ACRS) COMPARTMENT DOOR/COVER 

(57) BENEATH INSTRUMENT PANEL 
(53) PARCEL TRAY 

(48) KNEE RESTRAINT 
(86) VERTICAL CONSOLE 

(28) FOOT CONTROLS (INCL PARKING BRAKE PEDAL) 

(09) STEERING ASSEMBLY (SPECIFIC AREA UNKNOWN) 

(65) STEERING WHEEL 

(66) STEERING WHEEL COLUMN 

(59) TRANSMISSION LEVER ON COLUMN 

(03) ' HARDWARE fTEM (SPECIFIC AREA UNKNOWN) 

(82) INSTRUMENT^ 

(83) CONTROL KNOBS & LEVERS (FRONT) 

(84) PARKING BRAKE HANDLE IN FRONT 

(67) IGNITION KEY 
(06) MIRROR 

(04) HEATER OR AIR CONDITIONING DUCTS 

(01) AIR CONDITIONING OR VENTILATION OUTLETS 

(08) RADIO (BUILT IN) 

(58) ADD-ON TAPE DECK. RADIO. A/C 

(66) ROOF MOUNTED CONTROLS/CONSOLES 

Rear 

(88) surface of rear interior 

(23) rear window 

(39) rear window header 

(50) rear seat cushion & back 



Interior-General 

(11) transmission selection lever (location unk) 
transmission lever on steering column 
transmission lever on floor or console 
(07) parking brake handle (location unknown) 
(84) parking brake handle in front 

parking brake handle on floor or console 
foot controls (incl. marking brake pedal) 



(59) 
(44) 



(85) 
(28) 



(29) FRONT SEAT-BACKS 

(51) FRONT SEAT CUSHION 

(50) REAR SEAT CUSHION & BACK 

(49) ARMREST ON SEAT 

(89) UNOER SEAT BOTTOM 

(33) RESTRAINT SYSTEM HARDWARE 

(34) RESTRAINT SYSTEM WEBBING 
(87) AIR CUSHION SKIN (AJRBAG) 

(47) AJRBAG (ACRS) COMPARTMENT DOOR/COVER 
(46) AIRBAGGAS 

(48) KNEE RESTRAINT 

(30) HEAD RESTRAINT 

(42) CHILD SEAT RESTRAINTS 

(43) CHILD SEAT 

(31) INTERIOR LOOSE OBJECT 

(32) OTHER OCCUPANT^ 

(52) INTERNAL FLYING GLASS (FROM ANY SOURCE) 
(41) UNKNOWN INTERIOR SURFACE 



Sides 

(20) 
(19) 
(13) 
(24) 



SURFACE OF SIDE INTERIOR 

HARDWARE ON SIDE OR DOOR 
ARMREST ON SIDE OR DOOR 
COAT HOOK 



(22) WINDOW GLASS (SIDE) 
(21) WINDOW FRAMES (SIDE) 

(26) ROOF SIDE RAIL 

(14) A-PIUAR 

(15) B-PILLAR 

(16) C-PILLAR 

(17) D-PtLLAR 

Floor 

(40) FLOOR 

(27) console on floor or between seats 

(44) transmission lever on floor or console 

(85) parking brake handle on floor or console 

(28) foot controls (incl. parking brake pedal) 
(91) kickpanel 

Roof 

(25) roof or convertible top 

(10) sunvisor. fittings &or top molding 

(26) roof side rail 
(24) coat hook 

(18) DOME UGHT 

(39) BACKLIGHT HEADER 

(68) ROOF MOUNTED CONTROLS/CONSOLE 

(69) ROLL BAR 

Exterior Surface of Case Vehicle 
(37) outside surface of case vehicle 
(specific area unknown) 

(35) hood of case vehicle 

(60) exterior of case vehicle (eg 
outside mirrors, antenna, trim) 

(62) exterior side roof rail of case vehicle 

(63) trunk ud of case vehicle 

(64) tires of case vehicle 

Beyond Case Vehicle Boundary 

(36) area exterior to car (specific area unk) 

(70) hood of other vehicle 

(71) other vehicle exterior hardware (eg. 
outside mirrors. antenna. trim) 

(73) exterior side roof rail of other vehicle 

(74) headlight or front grill of other veh. 

(75) trunk of other vehicle 

(76) outside surface of other vehicle 

(77) tires of other vehicle 

(78) GROUND 

(79) WATER 

(80) exterior object (not vehicle ground, 
or water please describe.) 

Penetrating Objects 
(61) other vehicle 

(72) objects (describe) 

Miscellaneous 

(00) no contact (invalid field form code) 
(38) other (e.g. fire describe) 
(90) spare tire 

(96) INDUCED 

(97) EJECTED, UNKNOWN CONTACT 

(98) IMPACT FORCE. •WHIPLASH". 
HYPEREXTENSION/COMPRESSION 

(99) UNKNOWN AREA OF CONTACT 



SZ 



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Duplicate columns 1-8 Module SL _C_ Format JL _2_ OCCUPANT INFORMATION OC-1 


from the previous card. 9 10 11 12 




Occupant Identification 


G>1 


Physical Description 




OCCUPANT NUMBER 


AGE IN YEARS 


\ 01 




13 14 


(00) LESS THAN 1 YEAR 






(98) 98 YEARS OR OLDER 


20 21 


ROLE OF OCCUPANT AT 1ST IMPACT 


«^ 


(99) UNKNOWN 




(1) MOTOR VEHICLE DRIVER 


_2 


AGE IN MONTHS 


as: 


(2) MOTOR VEHICLE PASSENGER 


IS 


(00) LESS THAN 1 MONTH 


(NOT DRIVER) 




(25) 25 MONTHS OR OLDER 


22 23 


(9) UNKNOWN 




(99) UNKNOWN 
MASS (kg) 


' 


! 
i 


Occupant Position 


i 


(999) UNKNOWN 3 <L l~% 


24 25 26 


ROW LOCATION 




HEIGHT (cm) 

(999) UNKNOWN C ^ *S*' 




(1) FRONT 


2 


42L 


(2) SECOND 


16 


27 28 29 


(3) THIRD 








(4) FOURTH 




SEX 


2 

30 


m OTHER: 




(1) MALE 

(2) FEMALE 


(8) EXTERNAL TO PASSENGER 


COMPARTMENT (EG. BED OF PICKUP) 




(9) UNKNOWN 




(9) UNKNOWN 








Medical Conditions 




LATERAL LOCATION 


/ 








TREATMENT/MORTALITY 


oo_ 


(1) LEFT 




(00) NONE 


(2) LEFT CENTER 


17 


(01) FIRST AID AT SCENE 


31 32 


(3) CENTER 




(02) TREATED AT HOSPITAUCLINIC 




(4) RIGHT CENTER 




BUT NOT ADMITTED 




(5) RIGHT | 


(03) HOSPITALIZED FOR OBSERVATION 




(6) ALL (LYING ON SEAT) 




LESS THAN 24 HOURS 




(8) EXTERNAL TO PASSENGER 




(04) HOSPITALIZED OVER 24 HOURS 




COMPARTMENT 




OR FOR SIGNIFICANT TREATMENT 




. (9) UNKNOWN 




(05) FATAL, DEAD AT SCENE 

(06) FATAL, DOA 

(07) FATAL, DEAD WITHIN 24 HOURS 




POSTURE 




(08) FATAL. DEAD 24 HOURS TO 






A&. 


31 DAYS LATER 




(10) SITTING ON SEAT 


(09) FATAL, DEAD 31 DAYS TO 




(1 1 ) SITTING ON SEAT IN ABNORMAL 


16 19 


1 YEAR LATER 




POSITION (E.G. FEET ON DASH, 




(10) FATAL DEAD WTTHIN UNKNOWN 




SIDEWAYS) 




PERIOD 




(12) SITTING ON CONSOLE 




(99) UNKNOWN 




(20) ON LAP OR IN ARMS 








(30) STANDING ON SEAT 




INJURY SEVERITY SCORE (ISS) 




(40) STANDING ON FLOOR 






&o 


(47) STANDING. EXTERNAL TO 




(99) UNKNOWN 


PASSENGER COMPARTMENT 






33 34 


(50) IN BASSINET 








(60) IN CHILD SEAT 




NON-IMPACT MED. CONDITIONS 




(65) IN CHILD HARNESS 




(0) NONE 


O 


(70) LYING ON SEAT 




(1) YES, TIME & TYPE UNKNOWN 


(80) LYING/SITTING ON PASSENGER 




(2) PRE-CRASH FATAL (CUNICAL 


35 


FLOOR 




DEATH AT WHEEL) 




(83) LYING/SITTING ON OTHER 




(3) PRE-CRASH NON-FATAL (E.G. 




OBJECT IN PASSENGER 




PRIOR INJURY, STROKE) 




COMPARTMENT: 




(4) PREGNANT 




(85) ON CARGO FLOOR/FOLDEO 




(5) POST-CRASH FATAL (DROWNING) 




SEAT-BACK 




(6) POST-CRASH NON-FATAL INJURY 




(87) LYING/SITTING, EXTERNAL TO 
PASSENGER COMPARTMENT 




(7) OTHER: 




(8) COMBINATION OF ABOVE 


(97) OTHER: 




(CIRCLE EACH) 




(99) UNKNOWN 

| 




(9) UNKNOWN 





BEST AVAILABLE COPY 



5? 



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Occupant Information OC-2 



Medical Conditions (cont.) 



POLICE INJURY SEVERITY 
CODE FOR THIS OCCUPANT 

(0) O - NO INJURY 

(1) C - POSSIBLE INJURY 

(2) B - NON-INCAPACITATING 

(3) A - INCAPACITATING INJURY 

(4) K- FATAL 

(5) INJURED, SEVERITY UNKNOWN 

(6) DIED PRIOR TO IMPACT 

(7) NON-FATAL INJURY, 

SEVERITY UNKNOWN 
(9) UNKNOWN 



Restraint System 



ACTIVE RESTRAINT SYSTEM 

(0) NONE 

(1) LAP BELT 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(9) UNKNOWN 



ACTIVE RESTRAINT SYSTEM USAGE 

(0) NONE (AVAILABLE BUT NOT USED) 

(1) LAP BELT ONLY 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(7) IMPROPER USAGE 

(8) NOT APPUCABIE (NONE AVAILABLE) 

(9) UNKNOWN 



PASSIVE RESTRAINT SYSTEM 

(0) NONE 

(1) AIRBAG INSTALLED 

(2) PASSIVE UPPER TORSO 
WITH KNEE BOLSTERS 

(3) PASSIVE UPPER TORSO 
WITHOUT KNEE BOLSTERS 

(4) PASSIVE LAP & UPPER TORSO 

(5) AIRBAG INSTALLED & 
PASSIVE RESTRAINT 

(7) OTHER: 

(9) UNKNOWN 



CHILD SEAT TYPE 

(00) NONE USED 

(01) YES. USED 

(02) INTEGRAL. Chrysler Mini-van 
(88) NOT APPLICABLE 

(ADULT OR OLDER CHILD) 
(99) UNKNOWN 

CHILD SEAT MAKE/MODEL 



o< 



37 



£Al€0> -<HiGL& AJ0T as m 



PASSIVE RESTRAINT SYSTEM USAGE 

(0) SYSTEM DEFEATED 

(1) AIRBAG NOT DEPLOYED 

(2) AIRBAG DEPLOYED 

(3) AIRBAG NOT REINSTALLED 

(4) PASSIVE UPPER TORSO USED 

(5) PASSIVE LAP & UPPER TORSO USED 

(6) SYSTEM USED IN MANUAL MODE 

(7) IMPROPER USAGE 

(8) NOT APPLICABLE (NOT ORIGINALLY 
EQUIPPED) 

(9) UNKNOWN 



Ejection 
degree of ejection 

(0) NONE 

(1) PARTIAL 

(2) COMPLETE 

(7) EJECTED. DEGREE UNKNOWN 
(9) UNKNOWN IF EJECTED 

AREA OF EJECTION 

(01) WINDOW, LEFT SIDE 

(02) WINDOW. RIGHT SIDE 

(03) WINDOW, REAR 

(04) DOOR, LEFT SIDE 

(05) DOOR, RIGHT SIDE 

(06) DOOR, REAR OR TAILGATE 

(07) WINDSHIELD 

(08) ROOF OR OPEN CONVERTIBLE OR 
FROM EXTERNAL AREA 

(96) EJECTED AREA UNKNOWN 

(97) OTHER AREA: 

(98) NOT APPLICABLE (NOT EJECTED) 

(99) UNKNOWN IF EJECTED 



Q 

43 



at 

44 4S 



IF OCCUPANT WAS EJECTED, DESCRIBE 
IN DETAIL BELOW: 



Head Restraint 
head restraint available 

FOR THIS POSITION 

(0) NOT EQUIPPED OR REMOVED 

(1) EQUIPPED 
(9) UNKNOWN 



60 



Occupant Information OC-3 



OCCUPANT EYEWEAR 

(0) NONE 

(1) GLASSES 



(2) 
(3) 



CONTACTS 

BOTH GLASSES AND CONTACTS 



(4) OTHER 

(8) NOT APPLICABLE 

(9) UNKNOWN 



a 



47 



SOURCE OF INFORMATION 



(0) 
0) 
(2) 

(3) 
(4) 
(5) 
(7) 
(8) 
(9) 



INTERVIEW 
HOSPITAL 
AUTOPSY 
POLICE 
OTHER 



LAY CORONER/EXTERNAL EXAM 
COMBINATION OF ABOVE (CIRCLE) 
NOT APPLICABLE 
UNKNOWN 



*/ 



BEST AVAILABLE COPY 



Occupant Information OC-4 



INDICATE LOCATION OF INJURIES. 



No injury 




62 



Duplicate columns 1-8 
from the previous card. 



Module . 



£L Format _Q L. 

10 11 12 



Injury Classification IC-1 



NOTE: Each line in the table below is a separate record (card). 
Duplicate columns 1 * 12 for each completed line. 



Occupant Injury Classification 



PRIMARY OIC 



ASSOCIATED OIC 



COMMENTS 



o 

c 

i 

z 
c 
z 

s 

3D 



z 

c 

a 



PLAC£ CONTACTS IN ORDER OF 
PROBABILITY (HOR1ZONTALL Y) . 
START WITH MOST PROBABLE 
IN 1ST CONTACT AREA COLUMN. 

AREA(S) OF POSSIBLE CONTACT 
1ST 2ND 






9 
2 



-< 

■ a 
m 
a 

£ 
1 



& 

i 



13-14 15-16 



17-18 



19-20 



COMMENTS 



21 22 23 24 25 



26 27 28 29 30 



C?2 



i 

1 



A>0 (as 



ToQ. t<J 



NOTE: USE ADDITIONAL PAGES IF NECESSARY. 



BEST AVAILABLE COPY 



<? 



Injury Classification IC-2 



CODES FOR AREAS OF POSSIBLE OCCUPANT CONTACT 



Front of Passenger Compartment 

(10) sunvisor. fitting^) a/or top molding 
(12) windshield 

(05) instrument panel (specific area unknown) 

(54) upper instrument panel (x) 

(55) midole instrument panel (y) 

(56) lower instrument panel (z) 
(81) ash tray (instrument panel) 

(02) GLOVE COMPARTMENT AREA 

(47) AJRBAG (ACRS) COMPARTMENT DOOR/COVER 

(57) BENEATH INSTRUMENT PANEL 
(53) PARCEL TRAY 

(46) KNEE RESTRAINT 
(86) VERTICAL CONSOLE 

(28) FOOT CONTROLS (INCL PARKING BRAKE PEDAL) 

(09) STEERING ASSEMBLY (SPECIFIC AREA UNKNOWN) 

(65) STEERING WHEEL 

(66) STEERING WHEEL COLUMN 

(59) TRANSMISSION LEVER ON COLUMN 

(03) ' HARDWARE TTEM (SPECIFIC AREA UNKNOWN) 

(82) INSTRUMENT^ 

(83) CONTROL KNOB(S) & LEVERS (FRONT) 

(84) PARKING BRAKE HANDLE IN FRONT 

(67) IGNITION KEY 
(06) MIRROR 

(04) heater or air conditioning ducts 

(01) air conditioning or ventilation outlet^ 
(08) radio (built in) 

(58) add-on tape deck. radio. ajc 

(68) roof mounted controls/consoles 

Rear 

(88) surface of rear interior 
(23) rear window 

(39) rear window header 

(50) rear seat cushion & back 

Interior-General 

(11) transmission selection lever (location unk) 

(59) transmission lever on steering column 
(44) transmission lever on floor or console 
(07) parking brake handle (loca tion unknown) 

(84) parking brake handle in front 

(85) parking brake handle on floor or console 

(28) foot controls (incl. farking brake pedal) 

(29) front seat-back^; 

(51) FRONT SEAT CUSHION 

(50) REAR SEAT CUSHION & BACK 
(49) ARMREST ON SEAT 

(89) UNOER SEAT BOTTOM 

(33) RESTRAINT SYSTEM HARDWARE 

(34) RESTRAINT SYSTEM WEBBING 
(87) AIR CUSHION SKIN (AJRBAG) 

(47) AJRBAG (ACRS) COMPARTMENT DOOR/COVER 
(46) AJRBAG GAS 

(48) KNEE RESTRAINT 

(30) HEAD RESTRAINT 

(42) CHILD SEAT RESTRAINTS 

(43) CHILD SEAT 

(31) INTERIOR LOOSE OBJECT 

(32) OTHER OCCUPANTS 

(52) INTERNAL FLYING GLASS (FROM ANY SOURCE) 
(41) UNKNOWN INTERIOR SURFACE 



Sides 




(20) 


SURFACE OF SIDE INTERIOR 


(19) 


HARDWARE ON SIDE OR DOOR 


(13) 


ARMREST ON SIOE OR DOOR 


(24) 


COAT HOOK 


(22) 


WINDOW GLASS (SIDE) 


(21) 


WINDOW FRAMES (SIOE) 


(26) 


ROOF SIDE RAIL 


(14) 


A-PILLAR 


(15) 


B-PIIXAR 


06) 


C-PIOAR 


(17) 


D-PILLAR 


Floor 




(40) 


FLOOR 



(27) CONSOLE ON FLOOR OR BETWEEN SEATS 
(44) TRANSMISSION LEVER ON aOOR OR CONSOLE 
(85) PARKING BRAKE HANDLE ON FLOOR OR CONSOLE 

(28) FOOT CONTROLS (INCL. PARKING BRAKE PEDAL) 
(91) K1CKPANEL 



Roof 

(25) 
(10) 



ROOF OR CONVERTIBLE TOP 

sunvisor, FrrriNGfs; a/or top molding 

(26) ROOF SIDE RAIL 

(24) COAT HOOK 

(16) DOME LIGHT 

(39) BACKLIGHT HEADER 

(68) ROOF MOUNTED CONTROLS/CONSOLE 

(69) ROLLBAR 

Exterior Surface of Case Vehicle 
(37) outside surface of case vehicle 
(specific area unknown) 

(35) hood of case vehicle 

(60) exterior of case vehicle (eg. 
outside mirrors. antenna trim) 

(62) exterior side roof rail of case vehicle 

(63) trunk ud of case vehicle 

(64) tires of case vehicle 

Beyond Case Vehicle Boundary 

(36) area exterior to car (specific area unk) 

(70) hood of other vehicle 

(71) other vehicle exterior hardware (eg 
outside mirrors. amtenna. trim) 

(73) exterior side roof rail of other vehicle 

(74) headlight or front grill of other veh. 

(75) trunk of other vehicle 

(76) outside surface of other vehicle 

(77) tires of other vehicle 

(78) GROUND 

(79) WATER 

(80) exterior object (not vehicle. ground, 
or water. please describe.) 

Penetrating Objects 
(61) other vehicle 

(72) objects (describe) 

Miscellaneous 

(00) no contact (invalid field form code) 
(38) other (eg fire. describe) 
(90) spare tire 

(96) INDUCED 

(97) EJECTED. UNKNOWN CONTACT 

(98) IMPACT FORCE. "WHIPLASH". 
HYPEREXTENSION/COMPRESSION 

(99) UNKNOWN AREA OF CONTACT 



w 



BEST AVAILABLE COPY 



TEAM REPORT NUMBER: 



BEST AVAILABLE COPY 



Duplicate columns 1-8 
from the previous card. 



Module £l J2_ Format JJ 2_ 

9 10 11 12 



Occupant Information OC-1 



Occupant Identification 
occupant number 

role of occupant at 1st impact 

(1) MOTOR VEHICLE DRIVER 

(2) MOTOR VEHICLE PASSENGER 

(NOT DRIVER) 
(9) UNKNOWN 



13 14 



6t 

3 

2 



15 



Occupant Position 



ROW LOCATION 



(2) 
(3) 
(4) 
(7) 
(8) 

0) 



FRONT 
SECOND 
THIRD 
FOURTH 
OTHER: _ 



EXTERNAL TO PASSENGER 
COMPARTMENT (EG. BED OF PICKUP) 
UNKNOWN 



LATERAL LOCATION 

(1) LEFT 

(2) LEFT CENTER 

(3) CENTER 

(4) RIGHT CENTER 

(5) RIGHT 

(6) ALL (LYING ON SEAT) 

(8) EXTERNAL TO PASSENGER 
COMPARTMENT 
. (9) UNKNOWN 



POSTURE 



(10) 

(11) 



(12) 
(20) 



(50) 
(60) 
(65) 
(70) 
(80) 

(83) 



SITTING ON SEAT 

SITTING ON SEAT IN ABNORMAL 

POSITION (E.G. FEET ON DASH, 

SIDEWAYS) 

SITTING ON CONSOLE 

ON LAP OR IN ARMS 
(30) STANDING ON SEAT 
(40) STANDING ON FLOOR 
(47) STANDING, EXTERNAL TO 

PASSENGER COMPARTMENT 

IN BASSINET 

IN CHILD SEAT 

IN CHILD HARNESS 

LYING ON SEAT 

LYING/SITTING ON PASSENGER 

FLOOR 

LYING/SITTING ON OTHER 

OBJECT IN PASSENGER 

COMPARTMENT: 



(85) 

(87) 

(97) 
(99) 



ON CARGO FLOOR/FOLDED 
S EAT- BACK 

LYING/SITTING, EXTERNAL TO 
PASSENGER COMPARTMENT 

OTHER: 

UNKNOWN 



Physical Description 
age in years 

(00) LESS THAN 1 YEAR 

(98) 98 YEARS OR OLDER 

(99) UNKNOWN 

AGE IN MONTHS 

(00) LESS THAN 1 MONTH 
(25) 25 MONTHS OR OLDER 
(99) UNKNOWN 



MASS (kg) 

(999) UNKNOWN 



16 



r 



/o 



16 19 



HEIGHT (cm) /// ^ * / 

(999) UNKNOWN 

SEX 

(1) MALE 

(2) FEMALE 
(9) UNKNOWN 



Medical Conditions 
treatment/mortality 

(00) NONE 

(01) FIRST AID AT SCENE 

(02) TREATED AT HOSPITAUCLINIC 
BUT NOT ADMITTED 

(03) HOSPITALIZED FOR OBSERVATION 
LESS THAN 24 HOURS 

(04) HOSPITALIZED OVER 24 HOURS 
OR FOR SIGNIFICANT TREATMENT 

(05) FATAL, DEAD AT SCENE 

(06) FATAL, DOA 

(07) FATAL. DEAD WITHIN 24 HOURS 

(08) FATAL, DEAD 24 HOURS TO 
31 DAYS LATER 

(09) FATAL, DEAD 31 DAYS TO 
1 YEAR LATER 

(10) FATAL DEAD WITHIN UNKNOWN 
PERIOD 

(99) UNKNOWN 

INJURY SEVERITY SCORE (ISS) 

(99) UNKNOWN 



NON-IMPACT MED. CONDITIONS 

(0) NONE 

(1 ) YES, TIME & TYPE UNKNOWN 

(2) PRE-CRASH FATAL (CLINICAL 
DEATH AT WHEEL) 

(3) PRE-CRASH NON-FATAL (E.G. 
PRIOR INJURY, STROKE) 

(4) PREGNANT 

(5) POST-CRASH FATAL (DROWNING) 

(6) POST-CRASH NON-FATAL INJURY 

(7) OTHER: 

(8) COMBINATION OF ABOVE 

(CIRCLE EACH) 

(9) UNKNOWN 



20 21 
22 23 



o& 



24 25 26 



27 28 29 



30 



OO 

31 32 



O0_ 

33 34 



35 



<£T 



BEST AVAILABLE COPY 



"7^" 



Occupant Information OC-2 



Medical Conditions (cont.) 



POLICE INJURY SEVERITY 
CODE FOR THIS OCCUPANT 

(0) O- NO INJURY 

(1) C - POSSIBLE INJURY 

(2) B - NON-INCAPACITATING 

(3) A - INCAPACITATING INJURY 

(4) K- FATAL 

(5) INJURED, SEVERITY UNKNOWN 

(6) DIED PRIOR TO IMPACT 

(7) NON-FATAL INJURY, 

SEVERITY UNKNOWN 
(9) UNKNOWN 



Restraint System 



ACTIVE RESTRAINT SYSTEM 

(0) NONE 

(1) LAP BELT 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(9) UNKNOWN 



ACTIVE RESTRAINT SYSTEM USAGE 

(0) NONE (AVAILABLE BUT NOT USED) 

(1) LAP BELT ONLY 

(2) SHOULDER HARNESS ONLY 

(3) BOTH LAP BELT & 
SHOULDER HARNESS 

(7) IMPROPER USAGE 

(8) NOT APPLICABLE (NONE A VAILABLE) 

(9) UNKNOWN 



PASSIVE RESTRAINT SYSTEM 

(0) NONE 

(1) AIRBAG INSTALLED 

(2) PASSIVE UPPER TORSO 
WITH KNEE BOLSTERS 

(3) PASSIVE UPPER TORSO 
WITHOUT KNEE BOLSTERS 

(4) PASSIVE LAP & UPPER TORSO 

(5) AIRBAG INSTALLED & 
PASSIVE RESTRAINT 

(7) OTHER: 

(9) UNKNOWN 



CHILD SEAT TYPE 

(00) NONE USED 

(01) YES. USED 

(02) INTEGRAL. Chiysler Mini-van 
(88) NOT APPLICABLE 

(ADULT OR OLDER CHILD) 
(99) UNKNOWN 

CHILD SEAT MAKE/MODEL 




AKSosr^A-RcLr 



Cti 



2 

36 



PASSIVE RESTRAINT SYSTEM USAGE 

(0) SYSTEM DEFEATED 

(1) AIRBAG NOT DEPLOYED 

(2) AIRBAG DEPLOYED 

(3) AIRBAG NOT REINSTALLED 

(4) PASSIVE UPPER TORSO USED 

(5) PASSIVE LAP & UPPER TORSO USED 

(6) SYSTEM USED IN MANUAL MODE 

(7) IMPROPER USAGE 

(8) NOT APPLICABLE (NOT ORIGINALLY 
EQUIPPED) 

(9) UNKNOWN 



Ejection 
degree of ejection 

(0) NONE 

(1) PARTIAL 

(2) COMPLETE 

(7) EJECTED, DEGREE UNKNOWN 
(9) UNKNOWN IF EJECTED 

AREA OF EJECTION 

(01) WINDOW, LEFT SIDE 

(02) WINDOW, RIGHT SIDE 

(03) WINDOW, REAR 

(04) DOOR, LEFT SIDE 

(05) DOOR, RIGHT SIDE 

(06) DOOR, REAR OR TAILGATE 

(07) WINDSHIELD 

(06) ROOF OR OPEN CONVERTIBLE OR 
FROM EXTERNAL AREA 

(96) EJECTED AREA UNKNOWN 

(97) OTHER AREA 

(98) NOT APPLICABLE (NOT EJECTED) 

(99) UNKNOWN IF EJECTED 



o 

43 



If 



44 45 



t 



40 



iwssws?"" 10 - oescribe 



Head Restraint 

head restraint available 
for this position 

(0) NOT EQUIPPED OR REMOVED 

(1) EQUIPPED 
(9) UNKNOWN 



66 



Occupant Information OC-3 


OCCUPANT EYEWEAR 

(0) NONE 

(1) GLASSES 

(2) CONTACTS 

(3) BOTH GLASSES AND CONTACTS 

(4) OTHER 

(8) NOT APPLICABLE 

(9) UNKNOWN 


47 


SOURCE OF INFORMATION 

(0) INTERVIEW 

(1) HOSPITAL 

(2) AUTOPSY 

(3) POLICE 

(4) OTHER 


44 


(5) LAY CORONER/EXTERNAL EXAM 

(7) COMBINATION OF ABOVE (CIRCLE) 

(8) NOT APPLICABLE 

(9) UNKNOWN 



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Occupant Information OC-4 



INDICATE LOCATION OF INJURIES. 




No Injury 




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from the previous card. 



Module J_ C Format JJ L_ 

9 10 11 12 



Injury Classification IC-1 



NOTE: Each line in the table below is a separate record (card). 
Duplicate columns 1 - 12 for each completed line. 



Occupant Injury Classification 



PRIMARY OIC 



ASSOCIATED OIC 



COMMENTS 



o 

c 
5 



z 
c 
z 

CD 

m 

3 



C 
Z 

c 

a 
m 

9 



PLACE CONTACTS IN ORDER OF 
PROBABILITY (HORIZONTALL Y) . 
START WITH MOST PROBABLE 
IN 1ST CONTACT AREA COLUMN 

AREA(S) OF POSSIBLE CONTACT 
1ST 2ND 



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C0 



SJ 
2 



s 

» 



-< 

8 

1 



9 
2 



CO 

i 



13-14 



15-16 



17-18 



19-20 



COMMENTS 



21 22 23 24 25 



26 27 28 29 30 



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Injury Classification IC-2 



CODES FOR AREAS OF POSSIBLE OCCUPANT CONTACT 



Front of Passenger Compartment 

(io) sunvisor. FirnNGfs; a/or top molding 

(12) WINDSHIELD 

(05) INSTRUMENT PANEL (SPECIFIC AREA UNKNOWN) 

(54) UPPER INSTRUMENT PANEL (X) 

(55) MIDDLE INSTRUMENT PANEL (Y) 

(56) LOWER INSTRUMENT PANEL (Z) 
(81) ASH TRAY (INSTRUMENT PANEL) 
(02) GLOVE COMPARTMENT AREA 

(47) AIRBAG (ACRS) COMPARTMENT DOOR/COVER 

(57) BENEATH INSTRUMENT PANEL 
(59) PARCEL TRAY 

(48) KNEE RESTRAINT 
(86) VERTICAL CONSOLE 

(28) FOOT CONTROLS (INCL PARKING BRAKE PEDAL) 

(09) STEERING ASSEMBLY (SPECIFIC AREA UNKNOWN) 

(65) STEERING WHEEL 

(66) STEERING WHEEL COLUMN 

(59) TRANSMISSION LEVER ON COLUMN 

(03) * HARDWARE ITEM (SPECIFIC AREA UNKNOWN) 

(82) INSTRUMENT^ 

(83) CONTROL KHOB(S) & LEVER(S) (FRONT) 

(84) PARKING BRAKE HANDLE IN FRONT 

(67) IGNITION KEY 
(06) MIRROR 

(04) heater or air conditioning ducts 

(01) air conditioning or ventilation outlets 

(08) radio (built in) 

(58) add-on tape deck. radio. a/c 

(68) roof mounted controls/consoles 

Rear 

(88) surface of rear interior 

(23) rear window 

(39) rear window header 

(50) rear seat cushion & back 



Interior-General 

(1 1) transmission selection lever (location unk) 
transmission lever on steering column 
transmission lever on floor or console 
(07) parking brake handle (location unknown) 
(84) parking brake handle in front 

PARKING BRAKE HANOLE ON FLOOR OR CONSOLE 
FOOT CONTROLS (INCL PARKING BRAKE PEDAL) 



(59) 
(44) 



(85) 
(28) 



(29) FRONT SEAT-BACK^; 

(51 ) FRONT SEAT CUSHION 

(50) REAR SEAT CUSHION & BACK 

(49) ARMREST ON SEAT 

(89) UNDER SEAT BOTTOM 



(33) 



Sides 




(20) 


SURFACE OF SIDE INTERIOR 


(19) 


HARDWARE ON SIDE OR DOOR 


(13) 


ARMREST ON SIDE OR DOOR 


(24) 


COATHOOK 


(22) 


WINDOW GLASS (SIDE) 


(21) 


WINDOW FRAMES (SIDE) 


(26) 


ROOF SIDE RAIL 


(14) 


A-PILLAR 


(15) 


B-PILLAR 


(16) 


OPILLAR 


(17) 


D-PILLAR 


Floor 




(40) 


FLOOR 



(27) CONSOLE ON FLOOR OR BETWEEN SEATS 

(44) TRANSMISSION LEVER ON FLOOR OR CONSOLE 

(85) PARKING BRAKE HANDLE ON FLOOR OR CONSOLE 

(28) FOOT CONTROLS (INCL PARKING BRAKE PEDAL) 
(91) KICKPANEL 



Roof 

(25) 
(10) 



RESTRAINT SYSTEM HARDWARE 

(34) RESTRAINT SYSTEM WEBBING 

(87) AIR CUSHION SKIN (AIRBAG) 

(47) AIRBAG (ACRS) COMPARTMENT DOOR/COVER 
(46) AIRBAG GAS 

(48) KNEE RESTRAINT 

(30) HEAD RESTRAINT 

(42) CHILD SEAT RESTRAINTS 

(43) CHILD SEAT 

(31 ) INTERIOR LOOSE OBJECT 

(32) OTHER OCCUPANT^ 

(52) INTERNAL FLYING GLASS (FROM ANY SOURCE) 

(41) UNKNOWN INTERIOR SURFACE 



ROOF OR CONVERTIBLE TOP 

SUNVISOR. FITTING^ &/OR TOP MOLDING 

(26) ROOF SIDE RAIL 

(24) COATHOOK 

(18) DOME LIGHT 

(39) BACKLIGHT HEADER 

(68) ROOF MOUNTED CONTROLS/CONSOLE 

(69) ROLL BAR 

Exterior Surface of Case Vehicle 
(37) outside surface of case vehicle 
(specific area unknown) 

(35) hood of case vehicle 

(60) exterior of case vehicle (e.g. 
outside mirrors, antenna, trim) 

(62) exterior side roof rail of case vehicle 

(63) trunk ud of case vehicle 

(64) TIRES OF CASE VEHICLE 

Beyono Case Vehicle Boundary 

(36) area exterior to car (specific area unk) 

(70) hood of other vehicle 

(71) other vehicle exterior hardware (eg 
outside mirrors, antenna, trim) 

(73) exterior side roof rail of other vehicle 

(74) headlight or front griu of other veh. 

(75) trunk of other vehicle 

(76) outside surface of other vehicle 

(77) tires of other vehicle 

(78) GROUND 

(79) WATER 

(80) exterior object (not vehicle, ground, 
or water. please describe.) 

Penetrating Objects 
(61) other vehicle 

(72) objects (describe) 

Miscellaneous 

(00) no contact (invalid field form code) 
(38) other (e.g. fire describe) 
(90) spare tire 

(96) INDUCED 

(97) EJECTED. UNKNOWN CONTACT 

(98) IMPACT FORCE. •WHIPLASH*. 
HYPEREXTENSION/COMPRESSION 

(99) UNKNOWN AREA OF CONTACT 



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